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URLhttps://en.wikipedia.org/wiki/Sertraline
Last Crawled2026-04-09 02:42:54 (2 days ago)
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Sertraline Clinical data Pronunciation ⓘ SUR -trə-leen Trade names Zoloft, Lustral, Setrona, others [ 1 ] AHFS / Drugs.com Monograph MedlinePlus a697048 License data US   DailyMed :  Sertraline Pregnancy category AU : C [ 2 ] Addiction liability None [ 3 ] Routes of administration By mouth Drug class Selective serotonin reuptake inhibitor (SSRI) ATC code N06AB06 ( WHO ) Legal status Legal status AU : S4 (Prescription only) BR : Class C1 (Other controlled substances) [ 4 ] CA : ℞-only NZ : Prescription only UK : POM (Prescription only) US : ℞-only In general: ℞ (Prescription only) Pharmacokinetic data Bioavailability 44% [ citation needed ] Protein binding 98.5% [ citation needed ] Metabolism Liver (primarily N - demethylation mainly by CYP2B6 ; also metabolism by CYP2C19 , others) [ 5 ] [ 9 ] Metabolites ‱ Desmethylsertraline ‱ Others (e.g., hydroxylated metabolites , glucuronide conjugates ) [ 5 ] Elimination half-life ‱ Sertraline: 26 hours (32 hours in females, 22 hours in males; range 13–45 hours) [ 5 ] [ 6 ] [ 7 ] [ 8 ] ‱ Desmethylsertraline: 62–104 hours [ 5 ] Excretion Urine (40–45%) [ 5 ] Feces (40–45%) [ 5 ] Identifiers IUPAC name (1 S ,4 S )-4-(3,4-Dichlorophenyl)- N -methyl-1,2,3,4-tetrahydronaphthalen-1-amine CAS Number 79617-96-2   PubChem CID 68617 IUPHAR/BPS 4798 DrugBank DB01104   ChemSpider 61881   UNII QUC7NX6WMB KEGG D02360   as HCl:  D00825   ChEBI CHEBI:9123   ChEMBL ChEMBL809   CompTox Dashboard ( EPA ) DTXSID6023577 Chemical and physical data Formula C 17 H 17 Cl 2 N Molar mass 306.23  g·mol −1 3D model ( JSmol ) Interactive image SMILES ClC1=CC=C([C@H]2C3=C([C@H](CC2)NC)C=CC=C3)C=C1Cl InChI InChI=1S/C17H17NCl2/c1-20-17-9-7-12(13-4-2-3-5-14(13)17)11-6-8-15(18)16(19)10-11/h2-6,8,10,12,17,20H,7,9H2,1H3/t12-,17-/m0/s1   Key:VGKDLMBJGBXTGI-SJCJKPOMSA-N      (verify) Sertraline , sold under the brand name Zoloft among others, is an antidepressant medication of the selective serotonin reuptake inhibitor (SSRI) class [ 10 ] used to treat major depressive disorder , generalized anxiety disorder , social anxiety disorder , obsessive–compulsive disorder (OCD), panic disorder , and premenstrual dysphoric disorder . [ 11 ] Although also having approval for post-traumatic stress disorder (PTSD), findings indicate it leads to only modest improvements in symptoms associated with this condition. [ 12 ] [ 13 ] The drug shares the common side effects and contraindications of other SSRIs, with high rates of nausea , diarrhea , headache , insomnia , mild sedation , dry mouth , and sexual dysfunction , but it appears not to lead to much weight gain , and its effects on cognitive performance are mild. In some patients, sexual dysfunction may persist even after the drug is discontinued, a condition known as post-SSRI sexual dysfunction ; regulatory agencies including the European Medicines Agency and Health Canada have recommended that sertraline's product labeling warn of this risk. [ 14 ] [ 15 ] Similar to other antidepressants, the use of sertraline for depression may be associated with a mildly elevated rate of suicidal thoughts in people under the age of 25 years old. It should not be used together with monoamine oxidase inhibitors (MAOIs): this combination may cause serotonin syndrome , which can be life-threatening in some cases. Sertraline taken during pregnancy is associated with an increase in congenital heart defects in newborns. [ 16 ] [ 17 ] Sertraline was developed by scientists at Pfizer and approved for medical use in the United States in 1991. It is on the World Health Organization's List of Essential Medicines [ 18 ] and available as a generic medication . [ 10 ] In 2016, sertraline was the most commonly prescribed psychotropic medication in the United States. [ 19 ] It was also the eleventh most commonly prescribed medication in the United States, with more than 42   million prescriptions in 2023, [ 20 ] [ 21 ] and sertraline ranks among the top 10 most prescribed medications in Australia between 2017 and 2023. [ 22 ] Sertraline's effectiveness is similar to that of other antidepressants in its class, such as fluoxetine and paroxetine , which are also considered first-line treatments and are better tolerated than the older tricyclic antidepressants . Sertraline has been approved for major depressive disorder , obsessive–compulsive disorder (OCD), post-traumatic stress disorder (PTSD), premenstrual dysphoric disorder , panic disorder , social anxiety disorder (SAD), and generalized anxiety disorder (GAD). Sertraline is approved for use in children with OCD. [ 23 ] In meta-analyses , sertraline efficacy is similar to that of other SSRI antidepressants, with an odds ratio for response in clinical depression of between 1.44 and 1.67. [ 24 ] [ 25 ] However, as with other antidepressants, the nature and clinical significance of this effect remain disputed. [ 26 ] [ 27 ] A major study of sertraline in a broad primary care population found improvements in general mental health, quality of life, and anxiety. [ 28 ] However, it failed to find significant effects on depression in either the mildly or severely depressed, and the clinical relevance and accuracy of the positive effects found have been questioned. [ 29 ] [ 30 ] In several double-blind studies, sertraline was consistently more effective than placebo for dysthymia , a more chronic variety of depression, and comparable to imipramine in that respect. Sertraline also improves the functional impairments of dysthymia to a similar degree whether group Cognitive-Behavioral Therapy is undergone or not. [ 31 ] Limited pediatric data also demonstrates a reduction in depressive symptoms in the pediatric population though remains a second-line therapy after fluoxetine. [ 32 ] [ 33 ] Comparison with other antidepressants [ edit ] In general, sertraline efficacy is similar to that of other antidepressants. [ 34 ] For example, a meta-analysis of 12 new-generation antidepressants showed that sertraline and escitalopram are the best in terms of efficacy and acceptability in the acute-phase treatment of adults with depression. [ 35 ] Comparative clinical trials demonstrated that sertraline is similar in efficacy against depression to moclobemide , [ 36 ] nefazodone , [ 37 ] escitalopram , bupropion , [ 38 ] citalopram , fluvoxamine , paroxetine , [ 35 ] venlafaxine , [ 39 ] and mirtazapine . [ 40 ] Sertraline may be more efficacious for the treatment of depression in the acute phase (first four weeks) than fluoxetine . [ 41 ] There are differences between sertraline and some other antidepressants in their efficacy in the treatment of different subtypes of depression and in their adverse effects. For severe depression, sertraline is as good as clomipramine but is better tolerated. [ 39 ] Sertraline appears to work better in melancholic depression than fluoxetine, paroxetine , and mianserin and is similar to the tricyclic antidepressants such as amitriptyline and clomipramine . [ 34 ] In the treatment of depression accompanied by OCD , sertraline performs significantly better than desipramine on the measures of both OCD and depression. [ 31 ] [ 42 ] Sertraline is equivalent to imipramine for the treatment of depression with co-morbid panic disorder, but it is better tolerated. [ 43 ] Compared with amitriptyline, sertraline offered a greater overall improvement in quality of life of depressed patients. [ 34 ] Depression in elderly [ edit ] Sertraline used for the treatment of depression in elderly (older than 60) patients is superior to placebo and comparable to another SSRI fluoxetine, and tricyclic antidepressants (TCAs) amitriptyline, nortriptyline and imipramine . Sertraline has much lower rates of adverse effects than these TCAs, with the exception of nausea, which occurs more frequently with sertraline. In addition, sertraline appears to be more effective than fluoxetine or nortriptyline in the older-than-70 subgroup. [ 44 ] Accordingly, a meta-analysis of antidepressants in older adults found that sertraline, paroxetine and duloxetine were better than placebo. [ 45 ] However, in a 2003 trial the effect size was modest, and there was no improvement in quality of life as compared to placebo . [ 46 ] With depression in dementia, there is no benefit of sertraline treatment compared to either placebo or mirtazapine . [ 47 ] Obsessive–compulsive disorder [ edit ] Sertraline is effective for the treatment of OCD in adults, [ 23 ] adolescents and children. [ 48 ] [ 49 ] [ 50 ] It was better tolerated and, based on intention-to-treat analysis , performed better than the gold standard of OCD treatment clomipramine . [ 51 ] Continuing sertraline treatment helps prevent relapses of OCD with long-term data supporting its use for up to 24 months. [ 52 ] The sertraline dosages necessary for the effective treatment of OCD are higher than the usual dosage for depression. [ 53 ] The onset of action is also slower for OCD than for depression. The treatment recommendation is to start treatment with half of the maximal recommended dose for at least two months. After that, the dose can be raised to the maximal recommended in the cases of unsatisfactory response. [ 54 ] Cognitive behavioral therapy alone is not more effective than sertraline in adolescents and children; however, a combination of these treatments is effective. [ 50 ] Sertraline is superior to placebo for the treatment of panic disorder . [ 23 ] The response rate was independent of the dose. In addition to decreasing the frequency of panic attacks by about 80% (vs. 45% for placebo) and decreasing general anxiety, sertraline resulted in an improvement in quality of life on most parameters. The patients rated as "improved" on sertraline reported better quality of life than the ones who "improved" on placebo. The authors of the study argued that the improvement achieved with sertraline is different and of a better quality than the improvement achieved with a placebo. [ 55 ] [ 56 ] Sertraline is equally effective for men and women, [ 56 ] and for patients with or without agoraphobia. [ 57 ] Previous unsuccessful treatment with benzodiazepines does not diminish its efficacy. [ 58 ] However, the response rate was lower for the patients with more severe panic. [ 57 ] Starting treatment simultaneously with sertraline and clonazepam , with subsequent gradual discontinuation of clonazepam, may accelerate the response. [ 59 ] Double-blind comparative studies found sertraline to have the same effect on panic disorder as paroxetine or imipramine . [ 60 ] While imprecise, comparison of the results of trials of sertraline with separate trials of other anti-panic agents ( clomipramine , imipramine , clonazepam, alprazolam , and fluvoxamine ) indicates approximate equivalence of these medications. [ 55 ] Other anxiety disorders [ edit ] Sertraline has been successfully used for the treatment of social anxiety disorder . [ 61 ] [ 62 ] All three major domains of the disorder (fear, avoidance, and physiological symptoms) respond to sertraline. [ 31 ] Maintenance treatment, after the response is achieved, prevents the return of the symptoms. [ 63 ] The improvement is greater among the patients with later, adult onset of the disorder. [ 64 ] In a comparison trial, sertraline was superior to exposure therapy , but patients treated with the psychological intervention continued to improve during a year-long follow-up, while those treated with sertraline deteriorated after treatment termination. [ 65 ] The combination of sertraline and cognitive behavioral therapy appears to be more effective in children and young people than either treatment alone. [ 66 ] Sertraline has not been approved for the treatment of generalized anxiety disorder ; however, several guidelines recommend it as a first-line medication referring to good quality controlled clinical trials. [ 67 ] [ 43 ] [ 52 ] Premenstrual dysphoric disorder [ edit ] Sertraline is effective in alleviating the symptoms of premenstrual dysphoric disorder , a severe form of premenstrual syndrome . [ 68 ] Significant improvement was observed in 50–60% of cases treated with sertraline vs. 20–30% of cases on placebo. The improvement began during the first week of treatment, and in addition to mood, irritability, and anxiety, improvement was reflected in better family functioning, social activity, and general quality of life. Work functioning and physical symptoms, such as swelling, bloating, and breast tenderness, were less responsive to sertraline. [ 69 ] [ 70 ] Taking sertraline only during the luteal phase , that is, the 12–14 days before menses is not as effective as continuous treatment. [ 68 ] Continuous treatment with sub-therapeutic doses of sertraline (25 mg vs. usual 50–100 mg) is also effective. [ 71 ] Sertraline is approved for the treatment of post-traumatic stress disorder (PTSD). [ 23 ] The National Institute for Clinical Excellence recommends it for patients who prefer drug treatment to a psychological one. [ 72 ] Other guidelines also suggest sertraline as a first-line option for pharmacological therapy . [ 73 ] [ 43 ] When necessary, long-term pharmacotherapy can be beneficial. [ 73 ] There are both negative and positive clinical trial results for sertraline, which may be explained by the types of psychological traumas , symptoms, and comorbidities included in the various studies. [ 52 ] Positive results were obtained in trials that included predominantly women (75%) with a majority (60%) having physical or sexual assault as the traumatic event. [ 73 ] Somewhat contrary to the above suggestions, a meta-analysis of sertraline clinical trials for PTSD found it to be statistically superior to placebo in the reduction of PTSD symptoms but the effect size was small. [ 12 ] Another meta-analysis relegated sertraline to the second line, proposing trauma focused psychotherapy as a first-line intervention. The authors noted that Pfizer had declined to submit the results of a negative trial for inclusion in the meta-analysis making the results unreliable. [ 13 ] Sertraline, when taken daily, can be useful for the treatment of premature ejaculation . [ 74 ] A disadvantage of sertraline is that it requires continuous daily treatment to delay ejaculation significantly. [ 75 ] A 2019 systematic review suggested that sertraline may be a good way to control anger , irritability , and hostility in depressed patients and patients with other comorbidities. [ 76 ] Sertraline is contraindicated in individuals taking monoamine oxidase inhibitors or the antipsychotic pimozide . Liquid formulations of sertraline contain ethanol and are therefore contraindicated with disulfiram . The prescribing information recommends that treatment of the elderly and patients with liver impairment "must be approached with caution". Due to the slower elimination of sertraline in these groups, their exposure to sertraline may be as high as three times the average exposure for the same dose. [ 23 ] Nausea, ejaculation failure, insomnia, diarrhea, dry mouth, somnolence, dizziness, tremor, headache, excessive sweating, fatigue, restless legs syndrome and decreased libido are the common adverse effects associated with sertraline with the greatest difference from placebo . Those that most often result in interruption of the treatment are nausea, diarrhea, and insomnia. [ 23 ] The incidence of diarrhea is higher with sertraline – especially when prescribed at higher doses – in comparison with other SSRIs . [ 77 ] Over more than six months of sertraline therapy for depression, people showed no significant weight increase. [ 78 ] A 30-month-long treatment with sertraline for OCD also resulted in no significant weight gain. [ 79 ] Although the difference did not reach statistical significance , the average weight gain was lower for fluoxetine (1%) but higher for citalopram , fluvoxamine and paroxetine (2.5%). Of the sertraline group, 4.5% gained a large amount of weight (defined as more than 7% gain). This result compares favorably with placebo, where, according to the literature, 3–6% of patients gained more than 7% of their initial weight. The large weight gain was observed only among female members of the sertraline group; the significance of this finding is unclear because of the small size of the group. [ 79 ] Over a two-week treatment of healthy volunteers, sertraline slightly improved verbal fluency but did not affect word learning, short-term memory , vigilance , flicker fusion time , choice reaction time , memory span , or psychomotor coordination . [ 80 ] [ 81 ] In spite of lower subjective rating, that is, feeling that they performed worse, no clinically relevant differences were observed in the objective cognitive performance in a group of people treated for depression with sertraline for 1.5 years as compared to healthy controls. [ 82 ] In children and adolescents taking sertraline for six weeks for anxiety disorders, 18 out of 20 measures of memory, attention, and alertness stayed unchanged. Divided attention was improved and verbal memory under interference conditions decreased marginally. Because of the large number of measures taken, it is possible that these changes were still due to chance. [ 83 ] The unique effect of sertraline on dopaminergic neurotransmission may be related to these effects on cognition and vigilance. [ 84 ] [ 85 ] Sertraline has a low level of exposure of an infant through the breast milk and is recommended as the preferred option for the antidepressant therapy of breast-feeding mothers. [ 86 ] [ 87 ] However, there is 29–42% increase in congenital heart defects among children whose mothers were prescribed sertraline during pregnancy, [ 16 ] [ 17 ] with sertraline use in the first trimester associated with 2.7-fold increase in septal heart defects . [ 16 ] Abrupt interruption of sertraline treatment may result in withdrawal or discontinuation syndrome . Dizziness, insomnia, anxiety, agitation, and irritability are common symptoms. [ 88 ] It typically occurs within a few days from drug discontinuation and lasts a few weeks. [ 89 ] The withdrawal symptoms for sertraline are less severe and frequent than for paroxetine, and more frequent than for fluoxetine . [ 88 ] [ 89 ] In most cases symptoms are mild, short-lived, and resolve without treatment. More severe cases are often successfully treated by temporary reintroduction of the drug with a slower tapering-off rate. [ 90 ] Sertraline and SSRI antidepressants in general may be associated with bruxism and other movement disorders . [ 91 ] [ 92 ] Sertraline appears to be associated with microscopic colitis , a rare condition of unknown etiology . [ 93 ] Like other SSRIs, sertraline is associated with sexual side effects, including sexual arousal disorder , erectile dysfunction and difficulty achieving orgasm . While nefazodone and bupropion do not have negative effects on sexual functioning, 67% of men on sertraline experienced ejaculation difficulties versus 18% before the treatment. [ 94 ] Sexual arousal disorder, defined as "inadequate lubrication and swelling for women and erectile difficulties for men", occurred in 12% of people on sertraline as compared with 1% of patients on placebo. The mood improvement resulting from the treatment with sertraline sometimes counteracted these side effects, so that sexual desire and overall satisfaction with sex stayed the same as before the sertraline treatment. However, under the action of placebo the desire and satisfaction slightly improved. [ 95 ] . Post-SSRI sexual dysfunction [ edit ] Post-SSRI sexual dysfunction (PSSD) is an iatrogenic condition in which sexual side effects persist after discontinuation of serotonin reuptake inhibiting antidepressants, including sertraline. [ 96 ] [ 14 ] Characteristic symptoms include genital numbness, pleasureless or weak orgasm, loss of libido, and erectile dysfunction ; non-sexual symptoms such as emotional blunting and cognitive impairment may also occur. [ 14 ] The condition can arise after even brief exposure to a serotonin reuptake inhibitor and may persist indefinitely; there is currently no established treatment. [ 97 ] The DSM-5 noted in 2013 that serotonin reuptake inhibitor-induced sexual dysfunction may persist after the agent is discontinued. [ 98 ] The UK's Medicines and Healthcare products Regulatory Agency received its first report of a sexual dysfunction persisting after an SSRI was stopped — involving fluoxetine — in 1991, and sertraline has been among the SSRIs most frequently implicated in subsequent reports. [ 98 ] A 2023 retrospective cohort study of over 12,000 males estimated the risk of irreversible sexual dysfunction at approximately 0.46% of patients treated with serotonergic antidepressants, including SSRIs, though the actual prevalence remains uncertain and the condition is likely underreported. [ 99 ] A 2023 systematic review found that nearly every SSRI currently marketed has been associated with reports of PSSD, with escitalopram, citalopram, paroxetine, sertraline, and fluoxetine accounting for the majority of reported cases. [ 100 ] In 2019, the European Medicines Agency 's Pharmacovigilance Risk Assessment Committee (PRAC) recommended that product labels for all SSRIs and SNRIs, including sertraline, be updated to state that sexual dysfunction may be long-lasting even after treatment is stopped. [ 15 ] Health Canada followed with similar label updates in 2021. [ 98 ] In 2024, Australia's Therapeutic Goods Administration aligned all SSRI and SNRI product information to reflect this risk, noting that sertraline already carried a warning about persistent sexual dysfunction. [ 101 ] The US Food and Drug Administration (FDA) requires all antidepressants, including sertraline, to carry a boxed warning stating that antidepressants increase the risk of suicide in persons younger than 25 years. [ 102 ] [ 103 ] [ 104 ] This warning is based on statistical analyses conducted by two independent groups of FDA experts that found a 100% increase of suicidal thoughts and behavior in children and adolescents, and a 50% increase in the 18–24 age group. [ 105 ] [ 106 ] [ 107 ] Suicidal ideation and behavior in clinical trials are rare. For the above analysis, the FDA combined the results of 295 trials of 11 antidepressants for psychiatric indications to obtain statistically significant results. Considered separately, sertraline use in adults decreased the odds of suicidal behavior with a marginal statistical significance of 37% [ 107 ] or 50% [ 106 ] depending on the statistical technique used. The authors of the FDA analysis note that "given the large number of comparisons made in this review, chance is a very plausible explanation for this difference". [ 106 ] The more complete data submitted later by the sertraline manufacturer Pfizer indicated increased suicidal behavior. [ 108 ] Similarly, the analysis conducted by the UK MHRA found a 50% increase of odds of suicide-related events, not reaching statistical significance, in the patients on sertraline as compared to the ones on placebo. [ 109 ] [ 110 ] The therapeutic dosage varies according to the patient's age and/or clinical condition, but for all treatments with sertraline, it is recommended to start with lower dosages (25 to 50 mg/daily) and adjust according to the patient's therapeutic response, with a maximum maintenance dose of up to 200 mg per day. [ 111 ] Acute overdosage is often manifested by emesis , lethargy , ataxia , tachycardia and seizures . Plasma, serum or blood concentrations of sertraline and norsertraline, its major active metabolite , may be measured to confirm a diagnosis of poisoning in hospitalized patients or to aid in the medicolegal investigation of fatalities. [ 112 ] As with most other SSRIs its toxicity in overdose is considered relatively low. [ 113 ] [ 114 ] As with other SSRIs, sertraline may increase the risk of bleeding with NSAIDs ( ibuprofen , naproxen , mefenamic acid ), antiplatelet drugs , anticoagulants , omega-3 fatty acids , vitamin E , and garlic supplements due to sertraline's inhibitory effects on platelet aggregation via blocking serotonin transporters on platelets. [ 115 ] Sertraline, in particular, may potentially diminish the efficacy of levothyroxine . [ 116 ] Sertraline is a moderate inhibitor of CYP2D6 and CYP2B6 in vitro . [ 7 ] Accordingly, in human trials it caused increased blood levels of CYP2D6 substrates such as metoprolol , dextromethorphan , desipramine , imipramine and nortriptyline , as well as the CYP3A4 /CYP2D6 substrate haloperidol . [ 117 ] [ 118 ] [ 119 ] This effect is dose-dependent; for example, co-administration with 50 mg of sertraline resulted in 20% greater exposure to desipramine, while 150 mg of sertraline led to a 70% increase. [ 8 ] [ 120 ] In a placebo-controlled study, the concomitant administration of sertraline and methadone caused a 40% increase in blood levels of the latter, which is primarily metabolized by CYP2B6. [ 121 ] Bupropion is metabolized by CYP2B6, which is inhibited by sertraline, and this may result in an interaction between sertraline and bupropion. [ 122 ] [ 123 ] [ 124 ] Sertraline had a slight inhibitory effect on the metabolism of diazepam , tolbutamide , and warfarin , which are CYP2C9 or CYP2C19 substrates; the clinical relevance of this effect was unclear. [ 8 ] As expected from in vitro data, sertraline did not alter the human metabolism of the CYP3A4 substrates erythromycin , alprazolam , carbamazepine , clonazepam , and terfenadine ; neither did it affect metabolism of the CYP1A2 substrate clozapine . [ 8 ] [ 23 ] [ 125 ] [ 7 ] Sertraline did not affect the actions of digoxin and atenolol , which are not metabolized in the liver. [ 5 ] Case reports suggest that taking sertraline with phenytoin or zolpidem may induce sertraline metabolism and decrease its efficacy, [ 126 ] [ 127 ] and that taking sertraline with lamotrigine may increase the blood level of lamotrigine, possibly by inhibition of glucuronidation. [ 128 ] CYP2C19 inhibitor esomeprazole increased sertraline concentrations in blood plasma by approximately 40%. [ 129 ] Clinical reports indicate that interaction between sertraline and the MAOIs isocarboxazid and tranylcypromine may cause serotonin syndrome . In a placebo-controlled study in which sertraline was co-administered with lithium , 35% of the subjects experienced tremors, while none of those taking placebo did. [ 8 ] Molecular targets of sertraline [ 130 ] Site K i (nM) Species References SERT Tooltip Serotonin transporter 0.15–3.3 Human [ 131 ] [ 132 ] [ 133 ] NET Tooltip Norepinephrine transporter 420–925 Human [ 131 ] [ 132 ] [ 133 ] DAT Tooltip Dopamine transporter 22–315 Human [ 131 ] [ 132 ] [ 133 ] 5-HT 1A 35000+ Human [ 134 ] 5-HT 2A 2207 Rat [ 133 ] 5-HT 2C 2298 Pig [ 133 ] α 1A 1900 Human [ 135 ] α 1B 3500 Human [ 135 ] α 1D 2500 Human [ 135 ] α 2 477–4100 Human [ 132 ] [ 134 ] D 2 10700 Human [ 134 ] H 1 24000 Human [ 134 ] mACh Tooltip Muscarinic acetylcholine receptors 427–2100 Human [ 133 ] [ 134 ] [ 136 ] σ 1 32–57 Rat [ 137 ] [ 138 ] σ 2 5297 Rat [ 138 ] Values are K i (nM), unless otherwise noted. The smaller the value, the more strongly the drug binds to or inhibits the site. Sertraline is a selective serotonin reuptake inhibitor (SSRI). By binding to the serotonin transporter (SERT) it inhibits neuronal reuptake of serotonin and potentiates serotonergic activity in the central nervous system . [ 23 ] Over time, this leads to a downregulation of pre-synaptic 5-HT 1A receptors, which is associated with an improvement in passive stress tolerance, and delayed downstream increase in expression of brain-derived neurotrophic factor (BDNF), which may contribute to a reduction in negative affective biases. [ 139 ] [ 140 ] It does not significantly affect histamine , acetylcholine , GABA or benzodiazepine receptors. [ 23 ] Sertraline also shows relatively high activity as an inhibitor of the dopamine transporter (DAT) occupying ~20% of DAT receptors at doses 200mg and above, [ 131 ] [ 141 ] [ 142 ] and antagonist of the sigma σ 1 receptor (but not the σ 2 receptor ). [ 137 ] [ 138 ] [ 143 ] However, sertraline affinity for its main target (SERT) is much greater than its affinity for σ 1 receptor and DAT. [ 130 ] [ 131 ] [ 138 ] [ 137 ] Although there could be a role for the σ 1 receptor in the pharmacology of sertraline, the significance of this receptor in its actions is unclear. [ 34 ] Similarly, the clinical relevance of sertraline's blockade of the dopamine transporter is uncertain. [ 131 ] Sertraline is a REDD1-dependent mTOR inhibitor . It blocks AKT /mTOR pathway and has autophagy -inducing activity. [ 144 ] [ 145 ] [ 146 ] [ 147 ] Desmethylsertraline , the major metabolite of sertraline Following a single oral dose of sertraline, mean peak blood levels of sertraline occur between 4.5 and 8.4 hours. [ 5 ] Bioavailability is likely linear and dose-proportional over a dose range of 150 to 200 mg. [ 5 ] Concomitant intake of sertraline with food slightly increases sertraline peak levels and total exposure. [ 5 ] There is an approximate 2-fold accumulation of sertraline with continuous administration and steady-state levels are reached within one week. [ 5 ] Sertraline is highly plasma protein bound (98.5%) across a concentration range of 20 to 500 ng/mL. [ 5 ] Despite the high plasma protein binding, sertraline and its metabolite desmethylsertraline at respective tested concentrations of 300 ng/mL and 200 ng/mL were found not to interfere with the plasma protein binding of warfarin and propranolol , two other highly plasma protein-bound drugs. [ 5 ] Sertraline is subject to extensive first-pass metabolism , as indicated by a small study of radiolabeled sertraline in which less than 5% of plasma radioactivity was unchanged sertraline in two males. [ 5 ] The principal metabolic pathway for sertraline is N -demethylation into desmethylsertraline ( N -desmethylsertraline) mainly by CYP2B6 . [ 5 ] [ 9 ] Reduction , hydroxylation , and glucuronide conjugation of both sertraline and desmethylsertraline also occur. [ 5 ] Desmethylsertraline, while pharmacologically active , is substantially (50-fold) weaker than sertraline as a serotonin reuptake inhibitor and its influence on the clinical effects of sertraline is thought to be negligible. [ 5 ] [ 132 ] [ 148 ] Based on in vitro studies, sertraline is metabolized by multiple cytochrome 450 isoforms ; [ 9 ] [ 149 ] however, it appears that in the human body CYP2C19 plays the most important role, followed by CYP2B6 . [ 150 ] In addition to the cytochrome P450 system, sertraline can be oxidatively deaminated in vitro by monoamine oxidases ; [ 5 ] however, this metabolic pathway has never been studied in vivo . [ 9 ] The elimination half-life of sertraline is on average 26 hours, with a range of 13 to 45 hours. [ 5 ] [ 8 ] The elimination half-life of desmethylsertraline is 62 to 104 hours. [ 5 ] In a small study of two people, sertraline was excreted to similar degrees in urine and feces (40 to 45% each within 9 days). [ 5 ] Unchanged sertraline was not detectable in urine, whereas 12 to 14% of unchanged sertraline was present in feces. [ 5 ] CYP2C19 and CYP2B6 are thought to be the key cytochrome P450 enzymes involved in the metabolism of sertraline. [ 150 ] Relative to CYP2C19 normal (extensive) metabolizers , poor metabolizers have 2.7-fold higher levels of sertraline [ 151 ] and intermediate metabolizers have 1.4-fold higher levels. [ 152 ] In contrast, CYP2B6 poor metabolizers have 1.6-fold higher levels of sertraline and intermediate metabolizers have 1.2-fold higher levels. [ 150 ] In terms of chemical structure , sertraline is a 1-aminotetralin . [ 153 ] Several notable analogues sertraline are known, including desmethylsertraline , dasotraline , tametraline , and lometraline . [ 153 ] Skeletal formulae of thiothixene, lometraline and tametraline, from which sertraline was derived. Commonalities to the structure of sertraline are highlighted in red. The history of sertraline dates back to the early 1970s when Pfizer chemist Reinhard Sarges invented a novel series of psychoactive compounds, including lometraline , based on the structures of the neuroleptics thiothixene and pinoxepin . [ 154 ] [ 155 ] Further work on these compounds led to tametraline , a norepinephrine and weaker dopamine reuptake inhibitor . Development of tametraline was soon stopped because of undesired stimulant effects observed in animals. A few years later, in 1977, pharmacologist Kenneth Koe , after comparing the structural features of a variety of reuptake inhibitors, became interested in the tametraline series. He asked another Pfizer chemist, Willard Welch, to synthesize some previously unexplored tametraline derivatives. Welch generated several potent norepinephrine and triple reuptake inhibitors, but to the surprise of the scientists, one representative of the generally inactive cis-analogs was a serotonin reuptake inhibitor. Welch then prepared stereoisomers of this compound, which were tested in vivo by animal behavioral scientist Albert Weissman. The most potent and selective (+)-isomer [ a ] was taken into further development and eventually named sertraline. Weissman and Koe recalled that the group did not set up to produce an antidepressant of the SSRI type—in that sense their inquiry was not "very goal driven", and the invention of the sertraline molecule was serendipitous . According to Welch, they worked outside the mainstream at Pfizer, and even "did not have a formal project team". The group had to overcome initial bureaucratic reluctance to pursue sertraline development, as Pfizer was considering licensing an antidepressant candidate from another company. [ 154 ] [ 158 ] [ 159 ] Sertraline was approved by the US Food and Drug Administration (FDA) in 1991 based on the recommendation of the Psychopharmacological Drugs Advisory Committee; it had already become available in the United Kingdom the previous year. [ 160 ] The FDA committee achieved a consensus that sertraline was safe and effective for the treatment of major depression . During the discussion, Paul Leber, the director of the FDA Division of Neuropharmacological Drug Products, noted that granting approval was a "tough decision", since the treatment effect on outpatients with depression had been "modest to minimal". Other experts emphasized that the drug's effect on inpatients had not differed from placebo and criticized the poor design of the clinical trials by Pfizer. [ 161 ] For example, 40% of participants dropped out of the trials, significantly decreasing their validity . [ 162 ] Until 2002, sertraline was only approved for use in adults ages 18 and over; that year, it was approved by the FDA for use in treating children aged 6 or older with severe OCD. In 2003, the UK Medicines and Healthcare products Regulatory Agency issued guidance that, apart from fluoxetine (Prozac), SSRIs are not suitable for the treatment of depression in patients under 18. [ 163 ] [ 164 ] However, sertraline can still be used in the UK for the treatment of OCD in children and adolescents. [ 165 ] In 2005, the FDA added a boxed warning concerning pediatric suicidal behavior to all antidepressants , including sertraline. In 2007, labeling was again changed to add a warning regarding suicidal behavior in young adults ages 18 to 24. [ 166 ] Society and culture [ edit ] Generic availability [ edit ] The US patent for Zoloft expired in 2006, [ 167 ] and sertraline is available in generic form and is marketed under many brand names worldwide. [ 1 ] In the US, Zoloft is marketed by Viatris after Upjohn was spun off from Pfizer. [ 168 ] [ 169 ] [ 170 ] Interest during COVID-19 pandemic [ edit ] Sertraline has been the most sought-after antidepressant worldwide before, during, and after the COVID-19 pandemic , according to Google Trends data. The pandemic has led to an increase in searches for antidepressants, with sertraline, fluoxetine , duloxetine , and venlafaxine showing the highest search volumes, whereas searches of citalopram decreased during the pandemic. [ 171 ] Sertraline may be useful to treat murine Zaire ebolavirus (murine EBOV). [ 172 ] The World Health Organization (WHO) considers this a promising area of research. [ 172 ] Lass-Flörl et al. , 2003 finds it significantly inhibits phospholipase B in the fungal genus Candida , reducing virulence . [ 173 ] Sertraline is also a very effective leishmanicide. [ 174 ] Specifically, Palit & Ali 2008 find that sertraline kills almost all promastigotes of Leishmania donovani . [ 174 ] Sertraline is strongly antibacterial against some species. [ 174 ] It is also known to act as a photosensitizer of bacterial surfaces. [ 175 ] In combination with antibacterials its photosensitization effect reverses antibacterial resistance . [ 175 ] As such sertraline shows promise for food preservation . [ 175 ] Lass-Flörl et al. , 2003 finds this compound acts as a fungicide against Candida parapsilosis . [ 176 ] Its anti- Cp effect is indeed due to its serotonergic activity and not its other effects. [ 176 ] Sertraline is a promising trypanocide . [ 177 ] It acts at several different life stages and against several strains . [ 177 ] Sertraline's trypanocidal mechanism of action is by way of interference with bioenergetics . 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Retrieved 17 June 2024 . ^ Erdoğan Kaya A, Oğur NB (September 2023). "The Impact of the COVID-19 Pandemic on the Interest in Antidepressants: An Analysis of Worldwide Internet Searches With Google Trends Data" . Cureus . 15 (9) e45558. doi : 10.7759/cureus.45558 . PMC   10508353 . PMID   37731683 . ^ a b  ‱ Cardile AP, Warren TK, Martins KA, Reisler RB, Bavari S (January 2017). "Will There Be a Cure for Ebola?" . Annual Review of Pharmacology and Toxicology . 57 (1). Annual Reviews : 329– 348. doi : 10.1146/annurev-pharmtox-010716-105055 . PMID   27959624 .  ‱ Johansen LM, DeWald LE, Shoemaker CJ, Hoffstrom BG, Lear-Rooney CM, Stossel A, et al. (June 2015). "A screen of approved drugs and molecular probes identifies therapeutics with anti-Ebola virus activity" . Science Translational Medicine . 7 (290). American Association for the Advancement of Science (AAAS): 290ra89. doi : 10.1126/scitranslmed.aaa5597 . PMID   26041706 . S2CID   88805622 . ^  ‱ Lass-Flörl C, Ledochowski M, Fuchs D, Speth C, Kacani L, Dierich MP, et al. (January 2003). "Interaction of sertraline with Candida species selectively attenuates fungal virulence in vitro" . FEMS Immunology and Medical Microbiology . 35 (1). Oxford University Press ( Federation of European Microbiological Societies ): 11– 15. doi : 10.1111/j.1574-695x.2003.tb00643.x . PMID   12589952 . S2CID   11240443 .  ‱ Schaller M, Borelli C, Korting HC, Hube B (November 2005). "Hydrolytic enzymes as virulence factors of Candida albicans ". Mycoses . 48 (6). Blackwell Publishing : 365– 377. doi : 10.1111/j.1439-0507.2005.01165.x . PMID   16262871 . S2CID   1356254 .  ‱ Lyte M, ed. (2016). Microbial Endocrinology: Interkingdom Signaling in Infectious Disease and Health . Advances in Experimental Medicine and Biology. Vol. 874. Cham, Switzerland : Springer. pp. xiii+374. doi : 10.1007/978-3-319-20215-0 . ISBN   978-3-319-20215-0 . OCLC   932167823 . S2CID   7784624 . ISBN   978-3-319-20214-3 . ISBN   978-3-319-79299-6 . : 349, 355   ‱ Cussotto S, Clarke G, Dinan TG, Cryan JF (May 2019). "Psychotropics and the Microbiome: a Chamber of Secrets..." Psychopharmacology . 236 (5). Springer Science and Business Media ( European Behavioural Pharmacology Society (EBPS)): 1411– 1432. doi : 10.1007/s00213-019-5185-8 . PMC   6598948 . PMID   30806744 . S2CID   71145305 . ^ a b c Cussotto S, Clarke G, Dinan TG, Cryan JF (May 2019). "Psychotropics and the Microbiome: a Chamber of Secrets..." Psychopharmacology . 236 (5). Springer Science and Business Media ( European Behavioural Pharmacology Society (EBPS)): 1411– 1432. doi : 10.1007/s00213-019-5185-8 . PMC   6598948 . PMID   30806744 . S2CID   71145305 . ^ a b c Maldonado-Carmona N, Ouk TS, Calvete MJ, Pereira MM, Villandier N, Leroy-Lhez S (April 2020). "Conjugating biomaterials with photosensitizers: advances and perspectives for photodynamic antimicrobial chemotherapy" . Paper. Photochemical & Photobiological Sciences . 19 (4). Royal Society of Chemistry (RSC): 445– 461. Bibcode : 2020PhPhS..19..445M . doi : 10.1039/C9PP00398C . PMID   32104827 . S2CID   211537822 . ^ a b Arreola R, Becerril-Villanueva E, Cruz-Fuentes C, Velasco-VelĂĄzquez MA, GarcĂ©s-Alvarez ME, Hurtado-Alvarado G, et al. (2015). "Immunomodulatory effects mediated by serotonin" . Journal of Immunology Research . 2015 354957. Hindawi Publishing Corporation . doi : 10.1155/2015/354957 . PMC   4417587 . PMID   25961058 . S2CID   17202427 . 354957. ^ a b c Hassanzadeh P, Atyabi F, Dinarvand R (2019). "The significance of artificial intelligence in drug delivery system design". Advanced Drug Delivery Reviews . 151– 152. Elsevier BV : 169– 190. doi : 10.1016/j.addr.2019.05.001 . PMID   31071378 . S2CID   149445737 . This review cites this study: Ferreira DD, Mesquita JT, da Costa Silva TA, Romanelli MM, da Gama Jaen Batista D, da Silva CF, et al. (2018). "Efficacy of sertraline against Trypanosoma cruzi : an in vitro and in silico study" . The Journal of Venomous Animals and Toxins Including Tropical Diseases . 24 (1) 30. Springer Science and Business Media LLC . doi : 10.1186/s40409-018-0165-8 . PMC   6208092 . PMID   30450114 . S2CID   53114045 . CEVAP/UNESP - Centro de Estudos de Venenos e Animais Peçonhentos SĂŁo Paulo State University. ^ "Sertraline". Drugs and Lactation Database (LactMed) . Bethesda (MD): National Institute of Child Health and Human Development. May 2025. PMID   30000250 . Bookshelf ID: NBK501191 . Retrieved 31 August 2025 . Wikimedia Commons has media related to Sertraline .
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[Jump to content](https://en.wikipedia.org/wiki/Sertraline#bodyContent) Main menu Main menu move to sidebar hide Navigation - [Main page](https://en.wikipedia.org/wiki/Main_Page "Visit the main page [z]") - [Contents](https://en.wikipedia.org/wiki/Wikipedia:Contents "Guides to browsing Wikipedia") - [Current events](https://en.wikipedia.org/wiki/Portal:Current_events "Articles related to current events") - [Random article](https://en.wikipedia.org/wiki/Special:Random "Visit a randomly selected article [x]") - [About Wikipedia](https://en.wikipedia.org/wiki/Wikipedia:About "Learn about Wikipedia and how it works") - [Contact us](https://en.wikipedia.org/wiki/Wikipedia:Contact_us "How to contact Wikipedia") Contribute - [Help](https://en.wikipedia.org/wiki/Help:Contents "Guidance on how to use and edit Wikipedia") - [Learn to edit](https://en.wikipedia.org/wiki/Help:Introduction "Learn how to edit Wikipedia") - [Community portal](https://en.wikipedia.org/wiki/Wikipedia:Community_portal "The hub for editors") - [Recent changes](https://en.wikipedia.org/wiki/Special:RecentChanges "A list of recent changes to Wikipedia [r]") - [Upload file](https://en.wikipedia.org/wiki/Wikipedia:File_upload_wizard "Add images or other media for use on Wikipedia") - [Special pages](https://en.wikipedia.org/wiki/Special:SpecialPages "A list of all special pages [q]") [![](https://en.wikipedia.org/static/images/icons/enwiki-25.svg) ![Wikipedia](https://en.wikipedia.org/static/images/mobile/copyright/wikipedia-wordmark-en-25.svg) ![The Free Encyclopedia](https://en.wikipedia.org/static/images/mobile/copyright/wikipedia-tagline-en-25.svg)](https://en.wikipedia.org/wiki/Main_Page) [Search](https://en.wikipedia.org/wiki/Special:Search "Search Wikipedia [f]") Appearance - [Donate](https://donate.wikimedia.org/?wmf_source=donate&wmf_medium=sidebar&wmf_campaign=en.wikipedia.org&uselang=en) - [Create account](https://en.wikipedia.org/w/index.php?title=Special:CreateAccount&returnto=Sertraline "You are encouraged to create an account and log in; however, it is not mandatory") - [Log in](https://en.wikipedia.org/w/index.php?title=Special:UserLogin&returnto=Sertraline "You're encouraged to log in; however, it's not mandatory. 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[o]") ## Contents move to sidebar hide - [(Top)](https://en.wikipedia.org/wiki/Sertraline) - [1 Medical uses](https://en.wikipedia.org/wiki/Sertraline#Medical_uses) Toggle Medical uses subsection - [1\.1 Depression](https://en.wikipedia.org/wiki/Sertraline#Depression) - [1\.1.1 Comparison with other antidepressants](https://en.wikipedia.org/wiki/Sertraline#Comparison_with_other_antidepressants) - [1\.1.2 Depression in elderly](https://en.wikipedia.org/wiki/Sertraline#Depression_in_elderly) - [1\.2 Obsessive–compulsive disorder](https://en.wikipedia.org/wiki/Sertraline#Obsessive%E2%80%93compulsive_disorder) - [1\.3 Panic disorder](https://en.wikipedia.org/wiki/Sertraline#Panic_disorder) - [1\.4 Other anxiety disorders](https://en.wikipedia.org/wiki/Sertraline#Other_anxiety_disorders) - [1\.5 Premenstrual dysphoric disorder](https://en.wikipedia.org/wiki/Sertraline#Premenstrual_dysphoric_disorder) - [1\.6 Other indications](https://en.wikipedia.org/wiki/Sertraline#Other_indications) - [2 Contraindications](https://en.wikipedia.org/wiki/Sertraline#Contraindications) - [3 Side effects](https://en.wikipedia.org/wiki/Sertraline#Side_effects) Toggle Side effects subsection - [3\.1 Sexual](https://en.wikipedia.org/wiki/Sertraline#Sexual) - [3\.2 Post-SSRI sexual dysfunction](https://en.wikipedia.org/wiki/Sertraline#Post-SSRI_sexual_dysfunction) - [3\.3 Suicide](https://en.wikipedia.org/wiki/Sertraline#Suicide) - [4 Therapeutic dosage](https://en.wikipedia.org/wiki/Sertraline#Therapeutic_dosage) - [5 Overdose](https://en.wikipedia.org/wiki/Sertraline#Overdose) - [6 Interactions](https://en.wikipedia.org/wiki/Sertraline#Interactions) - [7 Pharmacology](https://en.wikipedia.org/wiki/Sertraline#Pharmacology) Toggle Pharmacology subsection - [7\.1 Pharmacodynamics](https://en.wikipedia.org/wiki/Sertraline#Pharmacodynamics) - [7\.2 Pharmacokinetics](https://en.wikipedia.org/wiki/Sertraline#Pharmacokinetics) - [7\.2.1 Absorption](https://en.wikipedia.org/wiki/Sertraline#Absorption) - [7\.2.2 Distribution](https://en.wikipedia.org/wiki/Sertraline#Distribution) - [7\.2.3 Metabolism](https://en.wikipedia.org/wiki/Sertraline#Metabolism) - [7\.2.4 Elimination](https://en.wikipedia.org/wiki/Sertraline#Elimination) - [7\.3 Pharmacogenomics](https://en.wikipedia.org/wiki/Sertraline#Pharmacogenomics) - [8 Chemistry](https://en.wikipedia.org/wiki/Sertraline#Chemistry) - [9 History](https://en.wikipedia.org/wiki/Sertraline#History) - [10 Society and culture](https://en.wikipedia.org/wiki/Sertraline#Society_and_culture) Toggle Society and culture subsection - [10\.1 Generic availability](https://en.wikipedia.org/wiki/Sertraline#Generic_availability) - [10\.2 Brand names](https://en.wikipedia.org/wiki/Sertraline#Brand_names) - [10\.3 Interest during COVID-19 pandemic](https://en.wikipedia.org/wiki/Sertraline#Interest_during_COVID-19_pandemic) - [11 Research](https://en.wikipedia.org/wiki/Sertraline#Research) - [12 See also](https://en.wikipedia.org/wiki/Sertraline#See_also) - [13 References](https://en.wikipedia.org/wiki/Sertraline#References) - [14 External links](https://en.wikipedia.org/wiki/Sertraline#External_links) Toggle the table of contents # Sertraline 49 languages - [Ű§Ù„ŰčŰ±ŰšÙŠŰ©](https://ar.wikipedia.org/wiki/%D8%B3%D9%8A%D8%B1%D8%AA%D8%B1%D8%A7%D9%84%D9%8A%D9%86 "ŰłÙŠŰ±ŰȘŰ±Ű§Ù„ÙŠÙ† – Arabic") - [Asturianu](https://ast.wikipedia.org/wiki/Sertralina "Sertralina – Asturian") - [ŰȘÛ†Ű±Ú©ŰŹÙ‡](https://azb.wikipedia.org/wiki/%D8%B3%D8%B1%D8%AA%D8%B1%D8%A7%D9%84%DB%8C%D9%86 "۳۱ŰȘŰ±Ű§Ù„ÛŒÙ† – South Azerbaijani") - [БългарсĐșĐž](https://bg.wikipedia.org/wiki/%D0%A1%D0%B5%D1%80%D1%82%D1%80%D0%B0%D0%BB%D0%B8%D0%BD "ĐĄĐ”Ń€Ń‚Ń€Đ°Đ»ĐžĐœ – Bulgarian") - [àŠŹàŠŸàŠ‚àŠČàŠŸ](https://bn.wikipedia.org/wiki/%E0%A6%B8%E0%A6%BE%E0%A6%B0%E0%A6%9F%E0%A7%8D%E0%A6%B0%E0%A6%BE%E0%A6%B2%E0%A6%BF%E0%A6%A8 "àŠžàŠŸàŠ°àŠŸà§àŠ°àŠŸàŠČàŠżàŠš – Bangla") - [CatalĂ ](https://ca.wikipedia.org/wiki/Sertralina "Sertralina – Catalan") - [ČeĆĄtina](https://cs.wikipedia.org/wiki/Sertralin "Sertralin – Czech") - [Cymraeg](https://cy.wikipedia.org/wiki/Sertralin "Sertralin – Welsh") - [Dansk](https://da.wikipedia.org/wiki/Sertralin "Sertralin – Danish") - [Dagbanli](https://dag.wikipedia.org/wiki/%C5%8Aun_su:Doc_James/Sertraline "Ɗun su:Doc James/Sertraline – Dagbani") - [Deutsch](https://de.wikipedia.org/wiki/Sertralin "Sertralin – German") - [ΕλληΜÎčÎșÎŹ](https://el.wikipedia.org/wiki/%CE%A3%CE%B5%CF%81%CF%84%CF%81%CE%B1%CE%BB%CE%AF%CE%BD%CE%B7 "ÎŁÎ”ÏÏ„ÏÎ±Î»ÎŻÎœÎ· – Greek") - [Español](https://es.wikipedia.org/wiki/Sertralina "Sertralina – Spanish") - [Eesti](https://et.wikipedia.org/wiki/Sertraliin "Sertraliin – Estonian") - [Euskara](https://eu.wikipedia.org/wiki/Sertralina "Sertralina – Basque") - [ÙŰ§Ű±ŰłÛŒ](https://fa.wikipedia.org/wiki/%D8%B3%D8%B1%D8%AA%D8%B1%D8%A7%D9%84%DB%8C%D9%86 "۳۱ŰȘŰ±Ű§Ù„ÛŒÙ† – Persian") - [Suomi](https://fi.wikipedia.org/wiki/Sertraliini "Sertraliini – Finnish") - [Français](https://fr.wikipedia.org/wiki/Sertraline "Sertraline – French") - [Ghanaian Pidgin](https://gpe.wikipedia.org/wiki/Sertraline "Sertraline – Ghanaian Pidgin") - [ŚąŚ‘ŚšŚ™ŚȘ](https://he.wikipedia.org/wiki/%D7%A1%D7%A8%D7%98%D7%A8%D7%9C%D7%99%D7%9F "ŚĄŚšŚ˜ŚšŚœŚ™ŚŸ – Hebrew") - [Hrvatski](https://hr.wikipedia.org/wiki/Sertralin "Sertralin – Croatian") - [Magyar](https://hu.wikipedia.org/wiki/Szertralin "Szertralin – Hungarian") - [Bahasa Indonesia](https://id.wikipedia.org/wiki/Sertralin "Sertralin – Indonesian") - [Italiano](https://it.wikipedia.org/wiki/Sertralina "Sertralina – Italian") - [æ—„æœŹèȘž](https://ja.wikipedia.org/wiki/%E3%82%BB%E3%83%AB%E3%83%88%E3%83%A9%E3%83%AA%E3%83%B3 "ă‚»ăƒ«ăƒˆăƒ©ăƒȘン – Japanese") - [ÒšĐ°Đ·Đ°Ò›ŃˆĐ°](https://kk.wikipedia.org/wiki/%D0%A1%D0%B5%D1%80%D1%82%D1%80%D0%B0%D0%BB%D0%B8%D0%BD "ĐĄĐ”Ń€Ń‚Ń€Đ°Đ»ĐžĐœ – Kazakh") - [한ꔭ얎](https://ko.wikipedia.org/wiki/%EC%84%B8%EB%A5%B4%ED%8A%B8%EB%9E%84%EB%A6%B0 "섞넎튞랄늰 – Korean") - [Latina](https://la.wikipedia.org/wiki/Sertralinum "Sertralinum – Latin") - [LietuviĆł](https://lt.wikipedia.org/wiki/Sertralinas "Sertralinas – Lithuanian") - [LatvieĆĄu](https://lv.wikipedia.org/wiki/Sertral%C4%ABns "SertralÄ«ns – Latvian") - [Bahasa Melayu](https://ms.wikipedia.org/wiki/Sertralin "Sertralin – Malay") - [Nederlands](https://nl.wikipedia.org/wiki/Sertraline "Sertraline – Dutch") - [Norsk bokmĂ„l](https://no.wikipedia.org/wiki/Sertralin "Sertralin – Norwegian BokmĂ„l") - [àŹ“àŹĄàŹŒàŹżàŹ†](https://or.wikipedia.org/wiki/%E0%AC%B8%E0%AD%87%E0%AC%B0%E0%AD%8D%E0%AC%9F%E0%AD%8D%E0%AC%B0%E0%AC%BE%E0%AC%B2%E0%AC%BF%E0%AC%A8 "àŹžà­‡àŹ°à­àŹŸà­àŹ°àŹŸàŹČàŹżàŹš – Odia") - [Polski](https://pl.wikipedia.org/wiki/Sertralina "Sertralina – Polish") - [PortuguĂȘs](https://pt.wikipedia.org/wiki/Sertralina "Sertralina – Portuguese") - [RomĂąnă](https://ro.wikipedia.org/wiki/Sertralin%C4%83 "Sertralină – Romanian") - [РуссĐșĐžĐč](https://ru.wikipedia.org/wiki/%D0%A1%D0%B5%D1%80%D1%82%D1%80%D0%B0%D0%BB%D0%B8%D0%BD "ĐĄĐ”Ń€Ń‚Ń€Đ°Đ»ĐžĐœ – Russian") - [Srpskohrvatski / српсĐșĐŸŃ…Ń€ĐČатсĐșĐž](https://sh.wikipedia.org/wiki/Sertralin "Sertralin – Serbo-Croatian") - [Simple English](https://simple.wikipedia.org/wiki/Sertraline "Sertraline – Simple English") - [Slovenơčina](https://sl.wikipedia.org/wiki/Sertralin "Sertralin – Slovenian") - [СрпсĐșĐž / srpski](https://sr.wikipedia.org/wiki/Sertralin "Sertralin – Serbian") - [Svenska](https://sv.wikipedia.org/wiki/Sertralin "Sertralin – Swedish") - [ఀెà°Čుగు](https://te.wikipedia.org/wiki/%E0%B0%B8%E0%B1%86%E0%B0%B0%E0%B1%8D%E0%B0%9F%E0%B1%8D%E0%B0%B0%E0%B0%BE%E0%B0%B2%E0%B1%88%E0%B0%A8%E0%B1%8D "ఞెర్ట్రటà°Čైచ్ – Telugu") - [TĂŒrkçe](https://tr.wikipedia.org/wiki/Sertralin "Sertralin – Turkish") - [ĐŁĐșŃ€Đ°Ń—ĐœŃŃŒĐșĐ°](https://uk.wikipedia.org/wiki/%D0%A1%D0%B5%D1%80%D1%82%D1%80%D0%B0%D0%BB%D1%96%D0%BD "ĐĄĐ”Ń€Ń‚Ń€Đ°Đ»Ń–Đœ – Ukrainian") - [Tiáșżng Việt](https://vi.wikipedia.org/wiki/Sertraline "Sertraline – Vietnamese") - [é–©ć—èȘž / BĂąn-lĂąm-gĂ­](https://zh-min-nan.wikipedia.org/wiki/Sertraline "Sertraline – Minnan") - [äž­æ–‡](https://zh.wikipedia.org/wiki/%E8%88%8D%E6%9B%B2%E6%9E%97 "舍æ›Č林 – Chinese") [Edit links](https://www.wikidata.org/wiki/Special:EntityPage/Q407617#sitelinks-wikipedia "Edit interlanguage links") - [Article](https://en.wikipedia.org/wiki/Sertraline "View the content page [c]") - [Talk](https://en.wikipedia.org/wiki/Talk:Sertraline "Discuss improvements to the content page [t]") English - [Read](https://en.wikipedia.org/wiki/Sertraline) - [Edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit "Edit this page [e]") - [View history](https://en.wikipedia.org/w/index.php?title=Sertraline&action=history "Past revisions of this page [h]") Tools Tools move to sidebar hide Actions - [Read](https://en.wikipedia.org/wiki/Sertraline) - [Edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit "Edit this page [e]") - [View history](https://en.wikipedia.org/w/index.php?title=Sertraline&action=history) General - [What links here](https://en.wikipedia.org/wiki/Special:WhatLinksHere/Sertraline "List of all English Wikipedia pages containing links to this page [j]") - [Related changes](https://en.wikipedia.org/wiki/Special:RecentChangesLinked/Sertraline "Recent changes in pages linked from this page [k]") - [Upload file](https://en.wikipedia.org/wiki/Wikipedia:File_Upload_Wizard "Upload files [u]") - [Permanent link](https://en.wikipedia.org/w/index.php?title=Sertraline&oldid=1347773962 "Permanent link to this revision of this page") - 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For other uses, see [Lustral (disambiguation)](https://en.wikipedia.org/wiki/Lustral_\(disambiguation\) "Lustral (disambiguation)"). Pharmaceutical compound | | | |---|---| | [![](https://upload.wikimedia.org/wikipedia/commons/thumb/b/b4/Sertraline.svg/250px-Sertraline.svg.png)](https://en.wikipedia.org/wiki/File:Sertraline.svg) | | | [![](https://upload.wikimedia.org/wikipedia/commons/thumb/6/61/Sertraline-A-3D-balls.png/250px-Sertraline-A-3D-balls.png)](https://en.wikipedia.org/wiki/File:Sertraline-A-3D-balls.png) | | | Clinical data | | | Pronunciation | [/ˈsɜːrtrəˌliːn/](https://en.wikipedia.org/wiki/Help:IPA/English "Help:IPA/English") [ⓘ](https://en.wikipedia.org/wiki/File:LL-Q1860_\(eng\)-Naomi_Persephone_Amethyst_\(NaomiAmethyst\)-sertraline.wav "File:LL-Q1860 (eng)-Naomi Persephone Amethyst (NaomiAmethyst)-sertraline.wav") [*SUR\-trə-leen*](https://en.wikipedia.org/wiki/Help:Pronunciation_respelling_key "Help:Pronunciation respelling key") | | [Trade names](https://en.wikipedia.org/wiki/Drug_nomenclature#Trade_names "Drug nomenclature") | Zoloft, Lustral, Setrona, others[\[1\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Brand2015-1) | | [AHFS](https://en.wikipedia.org/wiki/American_Society_of_Health-System_Pharmacists "American Society of Health-System Pharmacists")/[Drugs.com](https://en.wikipedia.org/wiki/Drugs.com "Drugs.com") | [Monograph](https://www.drugs.com/monograph/sertraline-hydrochloride.html) | | [MedlinePlus](https://en.wikipedia.org/wiki/MedlinePlus "MedlinePlus") | [a697048](https://medlineplus.gov/druginfo/meds/a697048.html) | | [License data](https://en.wikipedia.org/wiki/Regulation_of_therapeutic_goods "Regulation of therapeutic goods") | US [DailyMed](https://en.wikipedia.org/wiki/DailyMed "DailyMed"): [Sertraline](https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=Sertraline) | | [Pregnancy category](https://en.wikipedia.org/wiki/Pregnancy_category "Pregnancy category") | AU : C[\[2\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Drugs.com_pregnancy-2) | | [Addiction liability](https://en.wikipedia.org/wiki/Addiction "Addiction") | None[\[3\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Hub2001-3) | | [Routes of administration](https://en.wikipedia.org/wiki/Route_of_administration "Route of administration") | [By mouth](https://en.wikipedia.org/wiki/Oral_administration "Oral administration") | | [Drug class](https://en.wikipedia.org/wiki/Drug_class "Drug class") | [Selective serotonin reuptake inhibitor](https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor "Selective serotonin reuptake inhibitor") (SSRI) | | [ATC code](https://en.wikipedia.org/wiki/Anatomical_Therapeutic_Chemical_Classification_System "Anatomical Therapeutic Chemical Classification System") | [N06AB06](https://en.wikipedia.org/wiki/ATC_code_N06 "ATC code N06") ([WHO](https://www.whocc.no/atc_ddd_index/?code=N06AB06)) | | Legal status | | | [Legal status](https://en.wikipedia.org/wiki/Regulation_of_therapeutic_goods "Regulation of therapeutic goods") | AU : [S4](https://en.wikipedia.org/wiki/Standard_for_the_Uniform_Scheduling_of_Medicines_and_Poisons#Schedule_4 "Standard for the Uniform Scheduling of Medicines and Poisons") (Prescription only) BR : [Class C1](https://en.wikipedia.org/wiki/Brazilian_Controlled_Drugs_and_Substances_Act#Class_C1 "Brazilian Controlled Drugs and Substances Act") (Other controlled substances)[\[4\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-4) CA : [℞-only](https://en.wikipedia.org/wiki/Prescription_drug "Prescription drug") NZ : Prescription only UK : [POM](https://en.wikipedia.org/wiki/Prescription_drug "Prescription drug") (Prescription only) US : [℞-only](https://en.wikipedia.org/wiki/Prescription_drug "Prescription drug") In general: ℞ (Prescription only) | | [Pharmacokinetic](https://en.wikipedia.org/wiki/Pharmacokinetics "Pharmacokinetics") data | | | [Bioavailability](https://en.wikipedia.org/wiki/Bioavailability "Bioavailability") | 44%\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\] | | [Protein binding](https://en.wikipedia.org/wiki/Plasma_protein_binding "Plasma protein binding") | 98\.5%\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\] | | [Metabolism](https://en.wikipedia.org/wiki/Drug_metabolism "Drug metabolism") | [Liver](https://en.wikipedia.org/wiki/Liver "Liver") (primarily *N*\-[demethylation](https://en.wikipedia.org/wiki/Demethylation "Demethylation") mainly by [CYP2B6](https://en.wikipedia.org/wiki/CYP2B6 "CYP2B6"); also metabolism by [CYP2C19](https://en.wikipedia.org/wiki/CYP2C19 "CYP2C19"), others)[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5)[\[9\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid15547048-9) | | [Metabolites](https://en.wikipedia.org/wiki/Metabolite "Metabolite") | ‱ [Desmethylsertraline](https://en.wikipedia.org/wiki/Desmethylsertraline "Desmethylsertraline") ‱ Others (e.g., [hydroxylated](https://en.wikipedia.org/wiki/Hydroxylation "Hydroxylation") [metabolites](https://en.wikipedia.org/wiki/Metabolite "Metabolite"), [glucuronide](https://en.wikipedia.org/wiki/Glucuronide "Glucuronide") [conjugates](https://en.wikipedia.org/wiki/Conjugation_\(biochemistry\) "Conjugation (biochemistry)"))[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) | | [Elimination half-life](https://en.wikipedia.org/wiki/Biological_half-life "Biological half-life") | ‱ Sertraline: 26 hours (32 hours in females, 22 hours in males; range 13–45 hours)[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5)[\[6\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-GG-6)[\[7\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16192315-7)[\[8\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12452737-8) ‱ Desmethylsertraline: 62–104 hours[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) | | [Excretion](https://en.wikipedia.org/wiki/Excretion "Excretion") | [Urine](https://en.wikipedia.org/wiki/Urine "Urine") (40–45%)[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) [Feces](https://en.wikipedia.org/wiki/Feces "Feces") (40–45%)[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) | | Identifiers | | | [IUPAC name](https://en.wikipedia.org/wiki/IUPAC_nomenclature_of_chemistry "IUPAC nomenclature of chemistry") (1*S*,4*S*)-4-(3,4-Dichlorophenyl)-*N*\-methyl-1,2,3,4-tetrahydronaphthalen-1-amine | | | [CAS Number](https://en.wikipedia.org/wiki/CAS_Registry_Number "CAS Registry Number") | [79617-96-2](https://commonchemistry.cas.org/detail?cas_rn=79617-96-2) ![check](https://upload.wikimedia.org/wikipedia/en/thumb/f/fb/Yes_check.svg/20px-Yes_check.svg.png)Y | | [PubChem](https://en.wikipedia.org/wiki/PubChem#CID "PubChem") CID | [68617](https://pubchem.ncbi.nlm.nih.gov/compound/68617) | | [IUPHAR/BPS](https://en.wikipedia.org/wiki/Guide_to_Pharmacology "Guide to Pharmacology") | [4798](https://www.guidetopharmacology.org/GRAC/LigandDisplayForward?ligandId=4798) | | [DrugBank](https://en.wikipedia.org/wiki/DrugBank "DrugBank") | [DB01104](https://www.drugbank.ca/drugs/DB01104) ![check](https://upload.wikimedia.org/wikipedia/en/thumb/f/fb/Yes_check.svg/20px-Yes_check.svg.png)Y | | [ChemSpider](https://en.wikipedia.org/wiki/ChemSpider "ChemSpider") | [61881](https://www.chemspider.com/Chemical-Structure.61881.html) ![check](https://upload.wikimedia.org/wikipedia/en/thumb/f/fb/Yes_check.svg/20px-Yes_check.svg.png)Y | | [UNII](https://en.wikipedia.org/wiki/Unique_Ingredient_Identifier "Unique Ingredient Identifier") | [QUC7NX6WMB](https://precision.fda.gov/uniisearch/srs/unii/QUC7NX6WMB) | | [KEGG](https://en.wikipedia.org/wiki/KEGG "KEGG") | [D02360](https://www.kegg.jp/entry/D02360) ![check](https://upload.wikimedia.org/wikipedia/en/thumb/f/fb/Yes_check.svg/20px-Yes_check.svg.png)Y as HCl: [D00825](https://www.kegg.jp/entry/D00825) ![check](https://upload.wikimedia.org/wikipedia/en/thumb/f/fb/Yes_check.svg/20px-Yes_check.svg.png)Y | | [ChEBI](https://en.wikipedia.org/wiki/ChEBI "ChEBI") | [CHEBI:9123](https://www.ebi.ac.uk/chebi/searchId.do?chebiId=CHEBI:9123) ![check](https://upload.wikimedia.org/wikipedia/en/thumb/f/fb/Yes_check.svg/20px-Yes_check.svg.png)Y | | [ChEMBL](https://en.wikipedia.org/wiki/ChEMBL "ChEMBL") | [ChEMBL809](https://www.ebi.ac.uk/chembl/explore/compound/ChEMBL809) ![check](https://upload.wikimedia.org/wikipedia/en/thumb/f/fb/Yes_check.svg/20px-Yes_check.svg.png)Y | | [CompTox Dashboard](https://en.wikipedia.org/wiki/CompTox_Chemicals_Dashboard "CompTox Chemicals Dashboard") ( EPA ) | [DTXSID6023577](https://comptox.epa.gov/dashboard/chemical/details/DTXSID6023577) [![Edit this at Wikidata](https://upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png)](https://www.wikidata.org/wiki/Q407617#P3117 "Edit this at Wikidata") | | Chemical and physical data | | | [Formula](https://en.wikipedia.org/wiki/Chemical_formula "Chemical formula") | C17H17Cl2N | | [Molar mass](https://en.wikipedia.org/wiki/Molar_mass "Molar mass") | 306\.23 g·mol−1 | | 3D model ([JSmol](https://en.wikipedia.org/wiki/JSmol "JSmol")) | [Interactive image](https://chemapps.stolaf.edu/jmol/jmol.php?model=ClC1%3DCC%3DC%28%5BC%40H%5D2C3%3DC%28%5BC%40H%5D%28CC2%29NC%29C%3DCC%3DC3%29C%3DC1Cl) | | [SMILES](https://en.wikipedia.org/wiki/Simplified_molecular-input_line-entry_system "Simplified molecular-input line-entry system") ClC1=CC=C(\[C@H\]2C3=C(\[C@H\](CC2)NC)C=CC=C3)C=C1Cl | | | [InChI](https://en.wikipedia.org/wiki/International_Chemical_Identifier "International Chemical Identifier") InChI=1S/C17H17NCl2/c1-20-17-9-7-12(13-4-2-3-5-14(13)17)11-6-8-15(18)16(19)10-11/h2-6,8,10,12,17,20H,7,9H2,1H3/t12-,17-/m0/s1 ![check](https://upload.wikimedia.org/wikipedia/en/thumb/f/fb/Yes_check.svg/20px-Yes_check.svg.png)Y Key:VGKDLMBJGBXTGI-SJCJKPOMSA-N ![check](https://upload.wikimedia.org/wikipedia/en/thumb/f/fb/Yes_check.svg/20px-Yes_check.svg.png)Y | | | [(verify)](https://en.wikipedia.org/w/index.php?title=Special:ComparePages&rev1=464389436&page2=Sertraline) | | **Sertraline**, sold under the brand name **Zoloft** among others, is an [antidepressant medication](https://en.wikipedia.org/wiki/Antidepressant "Antidepressant") of the [selective serotonin reuptake inhibitor](https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor "Selective serotonin reuptake inhibitor") (SSRI) class[\[10\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-AHFS2018-10) used to treat [major depressive disorder](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder"), [generalized anxiety disorder](https://en.wikipedia.org/wiki/Generalized_anxiety_disorder "Generalized anxiety disorder"), [social anxiety disorder](https://en.wikipedia.org/wiki/Social_anxiety_disorder "Social anxiety disorder"), [obsessive–compulsive disorder](https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_disorder "Obsessive–compulsive disorder") (OCD), [panic disorder](https://en.wikipedia.org/wiki/Panic_disorder "Panic disorder"), and [premenstrual dysphoric disorder](https://en.wikipedia.org/wiki/Premenstrual_dysphoric_disorder "Premenstrual dysphoric disorder").[\[11\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-11) Although also having approval for [post-traumatic stress disorder](https://en.wikipedia.org/wiki/Post-traumatic_stress_disorder "Post-traumatic stress disorder") (PTSD), findings indicate it leads to only modest improvements in symptoms associated with this condition.[\[12\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid25644881-12)[\[13\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid27126398-13) The drug shares the common [side effects](https://en.wikipedia.org/wiki/Side_effect "Side effect") and [contraindications](https://en.wikipedia.org/wiki/Contraindication "Contraindication") of other SSRIs, with high rates of [nausea](https://en.wikipedia.org/wiki/Nausea "Nausea"), [diarrhea](https://en.wikipedia.org/wiki/Diarrhea "Diarrhea"), [headache](https://en.wikipedia.org/wiki/Headache "Headache"), [insomnia](https://en.wikipedia.org/wiki/Insomnia "Insomnia"), mild [sedation](https://en.wikipedia.org/wiki/Somnolence "Somnolence"), [dry mouth](https://en.wikipedia.org/wiki/Dry_mouth "Dry mouth"), and [sexual dysfunction](https://en.wikipedia.org/wiki/Sexual_dysfunction "Sexual dysfunction"), but it appears not to lead to much [weight gain](https://en.wikipedia.org/wiki/Weight_gain "Weight gain"), and its effects on [cognitive performance](https://en.wikipedia.org/wiki/Cognition "Cognition") are mild. In some patients, sexual dysfunction may persist even after the drug is discontinued, a condition known as [post-SSRI sexual dysfunction](https://en.wikipedia.org/wiki/Post-SSRI_sexual_dysfunction "Post-SSRI sexual dysfunction"); regulatory agencies including the [European Medicines Agency](https://en.wikipedia.org/wiki/European_Medicines_Agency "European Medicines Agency") and [Health Canada](https://en.wikipedia.org/wiki/Health_Canada "Health Canada") have recommended that sertraline's product labeling warn of this risk.[\[14\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Healy2022-14)[\[15\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-PRAC2019-15) Similar to other antidepressants, the use of sertraline for depression may be associated with a mildly elevated rate of [suicidal thoughts](https://en.wikipedia.org/wiki/Suicidal_thoughts "Suicidal thoughts") in people under the age of 25 years old. It should not be used together with [monoamine oxidase inhibitors](https://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor "Monoamine oxidase inhibitor") (MAOIs): this combination may cause [serotonin syndrome](https://en.wikipedia.org/wiki/Serotonin_syndrome "Serotonin syndrome"), which can be life-threatening in some cases. Sertraline taken during pregnancy is associated with an increase in [congenital heart defects](https://en.wikipedia.org/wiki/Congenital_heart_defect "Congenital heart defect") in newborns.[\[16\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid30415641-16)[\[17\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid33354752-17) Sertraline was developed by scientists at [Pfizer](https://en.wikipedia.org/wiki/Pfizer "Pfizer") and approved for medical use in the United States in 1991. It is on the [World Health Organization's List of Essential Medicines](https://en.wikipedia.org/wiki/WHO_Model_List_of_Essential_Medicines "WHO Model List of Essential Medicines")[\[18\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-WHO23rd-18) and available as a [generic medication](https://en.wikipedia.org/wiki/Generic_medication "Generic medication").[\[10\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-AHFS2018-10) In 2016, sertraline was the most commonly prescribed psychotropic medication in the United States.[\[19\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-PsychCentral2-19) It was also the eleventh most commonly prescribed medication in the United States, with more than 42 million prescriptions in 2023,[\[20\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Top300Drugs-20)[\[21\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-21) and sertraline ranks among the top 10 most prescribed medications in Australia between 2017 and 2023.[\[22\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-22) Sertraline's [effectiveness](https://en.wikipedia.org/wiki/Effectiveness "Effectiveness") is similar to that of other antidepressants in its class, such as [fluoxetine](https://en.wikipedia.org/wiki/Fluoxetine "Fluoxetine") and [paroxetine](https://en.wikipedia.org/wiki/Paroxetine "Paroxetine"), which are also considered first-line treatments and are better tolerated than the older [tricyclic antidepressants](https://en.wikipedia.org/wiki/Tricyclic_antidepressants "Tricyclic antidepressants"). ## Medical uses \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=1 "Edit section: Medical uses")\] Sertraline has been approved for [major depressive disorder](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder"), [obsessive–compulsive disorder](https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_disorder "Obsessive–compulsive disorder") (OCD), [post-traumatic stress disorder](https://en.wikipedia.org/wiki/Post-traumatic_stress_disorder "Post-traumatic stress disorder") (PTSD), [premenstrual dysphoric disorder](https://en.wikipedia.org/wiki/Premenstrual_dysphoric_disorder "Premenstrual dysphoric disorder"), [panic disorder](https://en.wikipedia.org/wiki/Panic_disorder "Panic disorder"), [social anxiety disorder](https://en.wikipedia.org/wiki/Social_anxiety_disorder "Social anxiety disorder") (SAD), and [generalized anxiety disorder](https://en.wikipedia.org/wiki/Generalized_anxiety_disorder "Generalized anxiety disorder") (GAD). Sertraline is approved for use in children with OCD.[\[23\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-DailyMed-23) ### Depression \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=2 "Edit section: Depression")\] In [meta-analyses](https://en.wikipedia.org/wiki/Meta-analysis "Meta-analysis"), sertraline efficacy is similar to that of other SSRI antidepressants, with an [odds ratio](https://en.wikipedia.org/wiki/Odds_ratio "Odds ratio") for response in clinical depression of between 1.44 and 1.67.[\[24\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Jakobsen2017-24)[\[25\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-CiprianiFurukawa2018-25) However, as with other antidepressants, the nature and clinical significance of this effect remain disputed.[\[26\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Moncrieff2018-26)[\[27\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-BMJ2019-27) A major study of sertraline in a broad primary care population found improvements in general mental health, quality of life, and anxiety.[\[28\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Lewis2019-28) However, it failed to find significant effects on depression in either the mildly or severely depressed, and the clinical relevance and accuracy of the positive effects found have been questioned.[\[29\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Hengartner2020-29)[\[30\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Paludan202020-30) In several [double-blind](https://en.wikipedia.org/wiki/Double-blind "Double-blind") studies, sertraline was consistently more effective than [placebo](https://en.wikipedia.org/wiki/Placebo "Placebo") for [dysthymia](https://en.wikipedia.org/wiki/Dysthymia "Dysthymia"), a more chronic variety of depression, and comparable to [imipramine](https://en.wikipedia.org/wiki/Imipramine "Imipramine") in that respect. Sertraline also improves the functional impairments of dysthymia to a similar degree whether group Cognitive-Behavioral Therapy is undergone or not.[\[31\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid21456103-31) Limited pediatric data also demonstrates a reduction in depressive symptoms in the pediatric population though remains a second-line therapy after fluoxetine.[\[32\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-32)[\[33\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-33) #### Comparison with other antidepressants \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=3 "Edit section: Comparison with other antidepressants")\] In general, sertraline efficacy is similar to that of other antidepressants.[\[34\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11420570-34) For example, a meta-analysis of 12 new-generation antidepressants showed that sertraline and [escitalopram](https://en.wikipedia.org/wiki/Escitalopram "Escitalopram") are the best in terms of efficacy and acceptability in the acute-phase treatment of adults with depression.[\[35\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-cipriani-35) Comparative clinical trials demonstrated that sertraline is similar in efficacy against depression to [moclobemide](https://en.wikipedia.org/wiki/Moclobemide "Moclobemide"),[\[36\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid17168253-36) [nefazodone](https://en.wikipedia.org/wiki/Nefazodone "Nefazodone"),[\[37\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid8626364-37) [escitalopram](https://en.wikipedia.org/wiki/Escitalopram "Escitalopram"), [bupropion](https://en.wikipedia.org/wiki/Bupropion "Bupropion"),[\[38\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9448656-38) [citalopram](https://en.wikipedia.org/wiki/Citalopram "Citalopram"), [fluvoxamine](https://en.wikipedia.org/wiki/Fluvoxamine "Fluvoxamine"), [paroxetine](https://en.wikipedia.org/wiki/Paroxetine "Paroxetine"),[\[35\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-cipriani-35) [venlafaxine](https://en.wikipedia.org/wiki/Venlafaxine "Venlafaxine"),[\[39\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16870212-39) and [mirtazapine](https://en.wikipedia.org/wiki/Mirtazapine "Mirtazapine").[\[40\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16172440-40) Sertraline may be more efficacious for the treatment of depression in the acute phase (first four weeks) than [fluoxetine](https://en.wikipedia.org/wiki/Fluoxetine "Fluoxetine").[\[41\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-41) There are differences between sertraline and some other antidepressants in their efficacy in the treatment of different subtypes of depression and in their adverse effects. For severe depression, sertraline is as good as [clomipramine](https://en.wikipedia.org/wiki/Clomipramine "Clomipramine") but is better tolerated.[\[39\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16870212-39) Sertraline appears to work better in [melancholic depression](https://en.wikipedia.org/wiki/Melancholic_depression "Melancholic depression") than fluoxetine, [paroxetine](https://en.wikipedia.org/wiki/Paroxetine "Paroxetine"), and [mianserin](https://en.wikipedia.org/wiki/Mianserin "Mianserin") and is similar to the [tricyclic antidepressants](https://en.wikipedia.org/wiki/Tricyclic_antidepressants "Tricyclic antidepressants") such as [amitriptyline](https://en.wikipedia.org/wiki/Amitriptyline "Amitriptyline") and [clomipramine](https://en.wikipedia.org/wiki/Clomipramine "Clomipramine").[\[34\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11420570-34) In the treatment of depression accompanied by [OCD](https://en.wikipedia.org/wiki/OCD "OCD"), sertraline performs significantly better than [desipramine](https://en.wikipedia.org/wiki/Desipramine "Desipramine") on the measures of both OCD and depression.[\[31\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid21456103-31)[\[42\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid25969470-42) Sertraline is equivalent to imipramine for the treatment of depression with co-morbid panic disorder, but it is better tolerated.[\[43\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12516310-43) Compared with amitriptyline, sertraline offered a greater overall improvement in [quality of life](https://en.wikipedia.org/wiki/Quality_of_life "Quality of life") of depressed patients.[\[34\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11420570-34) #### Depression in elderly \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=4 "Edit section: Depression in elderly")\] Sertraline used for the treatment of depression in elderly (older than 60) patients is superior to placebo and comparable to another SSRI fluoxetine, and [tricyclic antidepressants](https://en.wikipedia.org/wiki/Tricyclic_antidepressants "Tricyclic antidepressants") (TCAs) amitriptyline, [nortriptyline](https://en.wikipedia.org/wiki/Nortriptyline "Nortriptyline") and [imipramine](https://en.wikipedia.org/wiki/Imipramine "Imipramine"). Sertraline has much lower rates of adverse effects than these TCAs, with the exception of nausea, which occurs more frequently with sertraline. In addition, sertraline appears to be more effective than fluoxetine or nortriptyline in the older-than-70 subgroup.[\[44\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12093324-44) Accordingly, a meta-analysis of antidepressants in older adults found that sertraline, [paroxetine](https://en.wikipedia.org/wiki/Paroxetine "Paroxetine") and [duloxetine](https://en.wikipedia.org/wiki/Duloxetine "Duloxetine") were better than placebo.[\[45\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-45) However, in a 2003 trial the [effect size](https://en.wikipedia.org/wiki/Effect_size "Effect size") was modest, and there was no improvement in [quality of life](https://en.wikipedia.org/wiki/Quality_of_life "Quality of life") as compared to [placebo](https://en.wikipedia.org/wiki/Placebo "Placebo").[\[46\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12832242-46) With depression in dementia, there is no benefit of sertraline treatment compared to either placebo or [mirtazapine](https://en.wikipedia.org/wiki/Mirtazapine "Mirtazapine").[\[47\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Banerjee2013-47) ### Obsessive–compulsive disorder \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=5 "Edit section: Obsessive–compulsive disorder")\] Sertraline is effective for the treatment of OCD in adults,[\[23\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-DailyMed-23) adolescents and children.[\[48\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-NIHR_Evidence_2022-48)[\[49\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Boaden_2020-49)[\[50\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Correll_2021-50) It was better tolerated and, based on [intention-to-treat analysis](https://en.wikipedia.org/wiki/Intention-to-treat_analysis "Intention-to-treat analysis"), performed better than the gold standard of OCD treatment [clomipramine](https://en.wikipedia.org/wiki/Clomipramine "Clomipramine").[\[51\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9393392-51) Continuing sertraline treatment helps prevent relapses of OCD with long-term data supporting its use for up to 24 months.[\[52\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid25081580-52) The sertraline dosages necessary for the effective treatment of OCD are higher than the usual dosage for depression.[\[53\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-medscape-53) The onset of action is also slower for OCD than for depression. The treatment recommendation is to start treatment with half of the maximal recommended dose for at least two months. After that, the dose can be raised to the maximal recommended in the cases of unsatisfactory response.[\[54\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16838823-54) [Cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy") alone is not more effective than sertraline in adolescents and children; however, a combination of these treatments is effective.[\[50\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Correll_2021-50) ### Panic disorder \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=6 "Edit section: Panic disorder")\] Sertraline is superior to placebo for the treatment of [panic disorder](https://en.wikipedia.org/wiki/Panic_disorder "Panic disorder").[\[23\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-DailyMed-23) The response rate was independent of the dose. In addition to decreasing the frequency of panic attacks by about 80% (vs. 45% for placebo) and decreasing general anxiety, sertraline resulted in an improvement in quality of life on most parameters. The patients rated as "improved" on sertraline reported better quality of life than the ones who "improved" on placebo. The authors of the study argued that the improvement achieved with sertraline is different and of a better quality than the improvement achieved with a placebo.[\[55\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid10945134-55)[\[56\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16292466-56) Sertraline is equally effective for men and women,[\[56\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16292466-56) and for patients with or without agoraphobia.[\[57\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11206597-57) Previous unsuccessful treatment with [benzodiazepines](https://en.wikipedia.org/wiki/Benzodiazepines "Benzodiazepines") does not diminish its efficacy.[\[58\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11199932-58) However, the response rate was lower for the patients with more severe panic.[\[57\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11206597-57) Starting treatment simultaneously with sertraline and [clonazepam](https://en.wikipedia.org/wiki/Clonazepam "Clonazepam"), with subsequent gradual discontinuation of clonazepam, may accelerate the response.[\[59\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Amrein-59) Double-blind comparative studies found sertraline to have the same effect on panic disorder as [paroxetine](https://en.wikipedia.org/wiki/Paroxetine "Paroxetine") or [imipramine](https://en.wikipedia.org/wiki/Imipramine "Imipramine").[\[60\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid21342080-60) While imprecise, comparison of the results of trials of sertraline with separate trials of other anti-panic agents ([clomipramine](https://en.wikipedia.org/wiki/Clomipramine "Clomipramine"), [imipramine](https://en.wikipedia.org/wiki/Imipramine "Imipramine"), clonazepam, [alprazolam](https://en.wikipedia.org/wiki/Alprazolam "Alprazolam"), and [fluvoxamine](https://en.wikipedia.org/wiki/Fluvoxamine "Fluvoxamine")) indicates approximate equivalence of these medications.[\[55\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid10945134-55) ### Other anxiety disorders \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=7 "Edit section: Other anxiety disorders")\] Sertraline has been successfully used for the treatment of [social anxiety disorder](https://en.wikipedia.org/wiki/Social_anxiety_disorder "Social anxiety disorder").[\[61\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-61)[\[62\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid17092192-62) All three major domains of the disorder (fear, avoidance, and physiological symptoms) respond to sertraline.[\[31\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid21456103-31) Maintenance treatment, after the response is achieved, prevents the return of the symptoms.[\[63\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid18374843-63) The improvement is greater among the patients with later, adult onset of the disorder.[\[64\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid17963189-64) In a comparison trial, sertraline was superior to [exposure therapy](https://en.wikipedia.org/wiki/Exposure_therapy "Exposure therapy"), but patients treated with the psychological intervention continued to improve during a year-long follow-up, while those treated with sertraline deteriorated after treatment termination.[\[65\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16318597-65) The combination of sertraline and [cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy") appears to be more effective in children and young people than either treatment alone.[\[66\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid23834458-66) Sertraline has not been approved for the treatment of [generalized anxiety disorder](https://en.wikipedia.org/wiki/Generalized_anxiety_disorder "Generalized anxiety disorder"); however, several guidelines recommend it as a first-line medication referring to good quality controlled clinical trials.[\[67\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-nice-gad-67)[\[43\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12516310-43)[\[52\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid25081580-52) ### Premenstrual dysphoric disorder \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=8 "Edit section: Premenstrual dysphoric disorder")\] Sertraline is effective in alleviating the symptoms of [premenstrual dysphoric disorder](https://en.wikipedia.org/wiki/Premenstrual_dysphoric_disorder "Premenstrual dysphoric disorder"), a severe form of [premenstrual syndrome](https://en.wikipedia.org/wiki/Premenstrual_syndrome "Premenstrual syndrome").[\[68\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Jespersen_2024-68) Significant improvement was observed in 50–60% of cases treated with sertraline vs. 20–30% of cases on placebo. The improvement began during the first week of treatment, and in addition to mood, irritability, and anxiety, improvement was reflected in better family functioning, social activity, and general quality of life. Work functioning and physical symptoms, such as swelling, bloating, and breast tenderness, were less responsive to sertraline.[\[69\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12215058-69)[\[70\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11972726-70) Taking sertraline only during the [luteal phase](https://en.wikipedia.org/wiki/Luteal_phase "Luteal phase"), that is, the 12–14 days before menses is not as effective as continuous treatment.[\[68\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Jespersen_2024-68) Continuous treatment with sub-therapeutic doses of sertraline (25 mg vs. usual 50–100 mg) is also effective.[\[71\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid26377947-71) ### Other indications \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=9 "Edit section: Other indications")\] Sertraline is approved for the treatment of [post-traumatic stress disorder](https://en.wikipedia.org/wiki/Post-traumatic_stress_disorder "Post-traumatic stress disorder") (PTSD).[\[23\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-DailyMed-23) The [National Institute for Clinical Excellence](https://en.wikipedia.org/wiki/National_Institute_for_Clinical_Excellence "National Institute for Clinical Excellence") recommends it for patients who prefer drug treatment to a psychological one.[\[72\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-NICE-PTSD-72) Other guidelines also suggest sertraline as a first-line option for [pharmacological therapy](https://en.wikipedia.org/wiki/Pharmacological_therapy "Pharmacological therapy").[\[73\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16734498-73)[\[43\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12516310-43) When necessary, long-term pharmacotherapy can be beneficial.[\[73\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16734498-73) There are both negative and positive clinical trial results for sertraline, which may be explained by the types of [psychological traumas](https://en.wikipedia.org/wiki/Psychological_trauma "Psychological trauma"), symptoms, and [comorbidities](https://en.wikipedia.org/wiki/Comorbidity "Comorbidity") included in the various studies.[\[52\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid25081580-52) Positive results were obtained in trials that included predominantly women (75%) with a majority (60%) having physical or sexual assault as the traumatic event.[\[73\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16734498-73) Somewhat contrary to the above suggestions, a meta-analysis of sertraline clinical trials for PTSD found it to be statistically superior to placebo in the reduction of PTSD symptoms but the effect size was small.[\[12\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid25644881-12) Another meta-analysis relegated sertraline to the second line, proposing [trauma focused psychotherapy](https://en.wikipedia.org/wiki/Trauma_focused_cognitive_behavioral_therapy "Trauma focused cognitive behavioral therapy") as a first-line intervention. The authors noted that [Pfizer](https://en.wikipedia.org/wiki/Pfizer "Pfizer") had declined to submit the results of a negative trial for inclusion in the meta-analysis making the results unreliable.[\[13\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid27126398-13) Sertraline, when taken daily, can be useful for the treatment of [premature ejaculation](https://en.wikipedia.org/wiki/Premature_ejaculation "Premature ejaculation").[\[74\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-74) A disadvantage of sertraline is that it requires continuous daily treatment to delay ejaculation significantly.[\[75\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid17983899-75) A 2019 [systematic review](https://en.wikipedia.org/wiki/Systematic_review "Systematic review") suggested that sertraline may be a good way to control [anger](https://en.wikipedia.org/wiki/Anger "Anger"), [irritability](https://en.wikipedia.org/wiki/Irritability "Irritability"), and [hostility](https://en.wikipedia.org/wiki/Hostility "Hostility") in depressed patients and patients with other comorbidities.[\[76\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid31126061-76) ## Contraindications \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=10 "Edit section: Contraindications")\] Sertraline is contraindicated in individuals taking [monoamine oxidase inhibitors](https://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor "Monoamine oxidase inhibitor") or the antipsychotic [pimozide](https://en.wikipedia.org/wiki/Pimozide "Pimozide"). Liquid formulations of sertraline contain [ethanol](https://en.wikipedia.org/wiki/Alcohol_\(medicine\) "Alcohol (medicine)") and are therefore contraindicated with [disulfiram](https://en.wikipedia.org/wiki/Disulfiram "Disulfiram"). The prescribing information recommends that treatment of the elderly and patients with liver impairment "must be approached with caution". Due to the slower elimination of sertraline in these groups, their exposure to sertraline may be as high as three times the average exposure for the same dose.[\[23\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-DailyMed-23) ## Side effects \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=11 "Edit section: Side effects")\] Nausea, ejaculation failure, insomnia, diarrhea, dry mouth, somnolence, dizziness, tremor, headache, excessive sweating, fatigue, [restless legs syndrome](https://en.wikipedia.org/wiki/Restless_legs_syndrome "Restless legs syndrome") and decreased [libido](https://en.wikipedia.org/wiki/Libido "Libido") are the common adverse effects associated with sertraline with the greatest difference from [placebo](https://en.wikipedia.org/wiki/Placebo "Placebo"). Those that most often result in interruption of the treatment are nausea, diarrhea, and insomnia.[\[23\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-DailyMed-23) The incidence of diarrhea is higher with sertraline – especially when prescribed at higher doses – in comparison with other [SSRIs](https://en.wikipedia.org/wiki/SSRIs "SSRIs").[\[77\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-ICP2014-77) Over more than six months of sertraline therapy for depression, people showed no significant weight increase.[\[78\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11105740-78) A 30-month-long treatment with sertraline for OCD also resulted in no significant weight gain.[\[79\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid15491240-79) Although the difference did not reach [statistical significance](https://en.wikipedia.org/wiki/Statistical_significance "Statistical significance"), the average weight gain was lower for [fluoxetine](https://en.wikipedia.org/wiki/Fluoxetine "Fluoxetine") (1%) but higher for [citalopram](https://en.wikipedia.org/wiki/Citalopram "Citalopram"), [fluvoxamine](https://en.wikipedia.org/wiki/Fluvoxamine "Fluvoxamine") and [paroxetine](https://en.wikipedia.org/wiki/Paroxetine "Paroxetine") (2.5%). Of the sertraline group, 4.5% gained a large amount of weight (defined as more than 7% gain). This result compares favorably with placebo, where, according to the literature, 3–6% of patients gained more than 7% of their initial weight. The large weight gain was observed only among female members of the sertraline group; the significance of this finding is unclear because of the small size of the group.[\[79\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid15491240-79) Over a two-week treatment of healthy volunteers, sertraline slightly improved verbal [fluency](https://en.wikipedia.org/wiki/Fluency "Fluency") but did not affect word learning, [short-term memory](https://en.wikipedia.org/wiki/Short-term_memory "Short-term memory"), [vigilance](https://en.wikipedia.org/wiki/Alertness "Alertness"), [flicker fusion time](https://en.wikipedia.org/wiki/Flicker_fusion_threshold "Flicker fusion threshold"), choice [reaction time](https://en.wikipedia.org/wiki/Reaction_time "Reaction time"), [memory span](https://en.wikipedia.org/wiki/Memory_span "Memory span"), or [psychomotor coordination](https://en.wikipedia.org/wiki/Motor_coordination "Motor coordination").[\[80\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11565624-80)[\[81\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12692706-81) In spite of lower subjective rating, that is, feeling that they performed worse, no clinically relevant differences were observed in the objective cognitive performance in a group of people treated for depression with sertraline for 1.5 years as compared to healthy controls.[\[82\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16485140-82) In children and adolescents taking sertraline for six weeks for anxiety disorders, 18 out of 20 measures of memory, attention, and alertness stayed unchanged. [Divided attention](https://en.wikipedia.org/wiki/Attention#Clinical_model "Attention") was improved and [verbal memory](https://en.wikipedia.org/wiki/Verbal_memory "Verbal memory") under [interference conditions](https://en.wikipedia.org/wiki/Interference_theory#Proactive_interference "Interference theory") decreased marginally. Because of the large number of measures taken, it is possible that these changes were still due to chance.[\[83\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16190792-83) The unique effect of sertraline on [dopaminergic](https://en.wikipedia.org/wiki/Dopaminergic "Dopaminergic") [neurotransmission](https://en.wikipedia.org/wiki/Neurotransmission "Neurotransmission") may be related to these effects on cognition and vigilance.[\[84\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-84)[\[85\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-85) Sertraline has a low level of exposure of an infant through the breast milk and is recommended as the preferred option for the antidepressant therapy of breast-feeding mothers.[\[86\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-86)[\[87\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid28440103-87) However, there is 29–42% increase in [congenital heart defects](https://en.wikipedia.org/wiki/Congenital_heart_defect "Congenital heart defect") among children whose mothers were prescribed sertraline during pregnancy,[\[16\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid30415641-16)[\[17\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid33354752-17) with sertraline use in the first trimester associated with 2.7-fold increase in [septal heart defects](https://en.wikipedia.org/wiki/Heart_septal_defect "Heart septal defect").[\[16\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid30415641-16) Abrupt interruption of sertraline treatment may result in [withdrawal or discontinuation syndrome](https://en.wikipedia.org/wiki/Antidepressant_discontinuation_syndrome "Antidepressant discontinuation syndrome"). Dizziness, insomnia, anxiety, agitation, and irritability are common symptoms.[\[88\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid23596418-88) It typically occurs within a few days from drug discontinuation and lasts a few weeks.[\[89\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid25721705-89) The withdrawal symptoms for sertraline are less severe and frequent than for paroxetine, and more frequent than for [fluoxetine](https://en.wikipedia.org/wiki/Fluoxetine "Fluoxetine").[\[88\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid23596418-88)[\[89\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid25721705-89) In most cases symptoms are mild, short-lived, and resolve without treatment. More severe cases are often successfully treated by temporary reintroduction of the drug with a slower tapering-off rate.[\[90\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-WarnerAFP-90) Sertraline and SSRI antidepressants in general may be associated with [bruxism](https://en.wikipedia.org/wiki/Bruxism "Bruxism") and other [movement disorders](https://en.wikipedia.org/wiki/Movement_disorders "Movement disorders").[\[91\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid32546134-91)[\[92\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-92) Sertraline appears to be associated with [microscopic colitis](https://en.wikipedia.org/wiki/Microscopic_colitis "Microscopic colitis"), a rare condition of unknown [etiology](https://en.wikipedia.org/wiki/Etiology "Etiology").[\[93\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid30881078-93) ### Sexual \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=12 "Edit section: Sexual")\] Like other SSRIs, sertraline is associated with sexual side effects, including [sexual arousal disorder](https://en.wikipedia.org/wiki/Sexual_arousal_disorder "Sexual arousal disorder"), [erectile dysfunction](https://en.wikipedia.org/wiki/Erectile_dysfunction "Erectile dysfunction") and difficulty achieving [orgasm](https://en.wikipedia.org/wiki/Orgasm "Orgasm"). While [nefazodone](https://en.wikipedia.org/wiki/Nefazodone "Nefazodone") and [bupropion](https://en.wikipedia.org/wiki/Bupropion "Bupropion") do not have negative effects on sexual functioning, 67% of men on sertraline experienced ejaculation difficulties versus 18% before the treatment.[\[94\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11229450-94) [Sexual arousal](https://en.wikipedia.org/wiki/Sexual_arousal "Sexual arousal") disorder, defined as "inadequate lubrication and swelling for women and erectile difficulties for men", occurred in 12% of people on sertraline as compared with 1% of patients on placebo. The mood improvement resulting from the treatment with sertraline sometimes counteracted these side effects, so that [sexual desire](https://en.wikipedia.org/wiki/Sexual_desire "Sexual desire") and overall satisfaction with sex stayed the same as before the sertraline treatment. However, under the action of placebo the desire and satisfaction slightly improved.[\[95\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid10363731-95). ### Post-SSRI sexual dysfunction \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=13 "Edit section: Post-SSRI sexual dysfunction")\] Main article: [Post-SSRI sexual dysfunction](https://en.wikipedia.org/wiki/Post-SSRI_sexual_dysfunction "Post-SSRI sexual dysfunction") [Post-SSRI sexual dysfunction](https://en.wikipedia.org/wiki/Post-SSRI_sexual_dysfunction "Post-SSRI sexual dysfunction") (PSSD) is an [iatrogenic](https://en.wikipedia.org/wiki/Iatrogenic "Iatrogenic") condition in which sexual side effects persist after discontinuation of serotonin reuptake inhibiting antidepressants, including sertraline.[\[96\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Bala2018-96)[\[14\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Healy2022-14) Characteristic symptoms include genital numbness, pleasureless or weak orgasm, loss of libido, and [erectile dysfunction](https://en.wikipedia.org/wiki/Erectile_dysfunction "Erectile dysfunction"); non-sexual symptoms such as [emotional blunting](https://en.wikipedia.org/wiki/Emotional_blunting "Emotional blunting") and cognitive impairment may also occur.[\[14\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Healy2022-14) The condition can arise after even brief exposure to a serotonin reuptake inhibitor and may persist indefinitely; there is currently no established treatment.[\[97\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Healy2018-97) The [DSM-5](https://en.wikipedia.org/wiki/DSM-5 "DSM-5") noted in 2013 that serotonin reuptake inhibitor-induced sexual dysfunction may persist after the agent is discontinued.[\[98\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Healy2024barriers-98) The UK's [Medicines and Healthcare products Regulatory Agency](https://en.wikipedia.org/wiki/Medicines_and_Healthcare_products_Regulatory_Agency "Medicines and Healthcare products Regulatory Agency") received its first report of a sexual dysfunction persisting after an SSRI was stopped — involving [fluoxetine](https://en.wikipedia.org/wiki/Fluoxetine "Fluoxetine") — in 1991, and sertraline has been among the SSRIs most frequently implicated in subsequent reports.[\[98\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Healy2024barriers-98) A 2023 retrospective cohort study of over 12,000 males estimated the risk of irreversible sexual dysfunction at approximately 0.46% of patients treated with serotonergic antidepressants, including SSRIs, though the actual prevalence remains uncertain and the condition is likely underreported.[\[99\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-BenSheetrit2023-99) A 2023 systematic review found that nearly every SSRI currently marketed has been associated with reports of PSSD, with escitalopram, citalopram, paroxetine, sertraline, and fluoxetine accounting for the majority of reported cases.[\[100\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Tarchi2023-100) In 2019, the [European Medicines Agency](https://en.wikipedia.org/wiki/European_Medicines_Agency "European Medicines Agency")'s [Pharmacovigilance Risk Assessment Committee](https://en.wikipedia.org/wiki/Pharmacovigilance_Risk_Assessment_Committee "Pharmacovigilance Risk Assessment Committee") (PRAC) recommended that product labels for all SSRIs and SNRIs, including sertraline, be updated to state that sexual dysfunction may be long-lasting even after treatment is stopped.[\[15\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-PRAC2019-15) [Health Canada](https://en.wikipedia.org/wiki/Health_Canada "Health Canada") followed with similar label updates in 2021.[\[98\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Healy2024barriers-98) In 2024, Australia's [Therapeutic Goods Administration](https://en.wikipedia.org/wiki/Therapeutic_Goods_Administration "Therapeutic Goods Administration") aligned all SSRI and SNRI product information to reflect this risk, noting that sertraline already carried a warning about persistent sexual dysfunction.[\[101\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-TGA2024-101) ### Suicide \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=14 "Edit section: Suicide")\] The US [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) requires all antidepressants, including sertraline, to carry a [boxed warning](https://en.wikipedia.org/wiki/Boxed_warning "Boxed warning") stating that antidepressants increase the risk of suicide in persons younger than 25 years.[\[102\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-102)[\[103\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-103)[\[104\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-104) This warning is based on statistical analyses conducted by two independent groups of FDA experts that found a 100% increase of suicidal thoughts and behavior in children and adolescents, and a 50% increase in the 18–24 age group.[\[105\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDA-105)[\[106\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDA2-106)[\[107\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDA3-107) [Suicidal ideation](https://en.wikipedia.org/wiki/Suicidal_ideation "Suicidal ideation") and behavior in clinical trials are rare. For the above analysis, the FDA combined the results of 295 trials of 11 antidepressants for psychiatric indications to obtain [statistically significant](https://en.wikipedia.org/wiki/Statistically_significant "Statistically significant") results. Considered separately, sertraline use in adults decreased the odds of suicidal behavior with a marginal statistical significance of 37%[\[107\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDA3-107) or 50%[\[106\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDA2-106) depending on the statistical technique used. The authors of the FDA analysis note that "given the large number of comparisons made in this review, chance is a very plausible explanation for this difference".[\[106\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDA2-106) The more complete data submitted later by the sertraline manufacturer Pfizer indicated increased suicidal behavior.[\[108\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-108) Similarly, the analysis conducted by the UK [MHRA](https://en.wikipedia.org/wiki/Medicines_and_Healthcare_products_Regulatory_Agency "Medicines and Healthcare products Regulatory Agency") found a 50% increase of odds of suicide-related events, not reaching statistical significance, in the patients on sertraline as compared to the ones on placebo.[\[109\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-109)[\[110\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid15718537-110) ## Therapeutic dosage \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=15 "Edit section: Therapeutic dosage")\] The therapeutic dosage varies according to the patient's age and/or clinical condition, but for all treatments with sertraline, it is recommended to start with lower dosages (25 to 50 mg/daily) and adjust according to the patient's therapeutic response, with a maximum maintenance dose of up to 200 mg per day.[\[111\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-111) ## Overdose \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=16 "Edit section: Overdose")\] Acute overdosage is often manifested by [emesis](https://en.wikipedia.org/wiki/Emesis "Emesis"), [lethargy](https://en.wikipedia.org/wiki/Lethargy "Lethargy"), [ataxia](https://en.wikipedia.org/wiki/Ataxia "Ataxia"), [tachycardia](https://en.wikipedia.org/wiki/Tachycardia "Tachycardia") and [seizures](https://en.wikipedia.org/wiki/Seizures "Seizures"). Plasma, serum or blood concentrations of sertraline and norsertraline, its major [active metabolite](https://en.wikipedia.org/wiki/Active_metabolite "Active metabolite"), may be measured to confirm a diagnosis of poisoning in hospitalized patients or to aid in the medicolegal investigation of fatalities.[\[112\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-112) As with most other SSRIs its toxicity in overdose is considered relatively low.[\[113\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Maudsley-113)[\[114\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-114) ## Interactions \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=17 "Edit section: Interactions")\] As with other SSRIs, sertraline may increase the risk of bleeding with [NSAIDs](https://en.wikipedia.org/wiki/Nonsteroidal_anti-inflammatory_drug "Nonsteroidal anti-inflammatory drug") ([ibuprofen](https://en.wikipedia.org/wiki/Ibuprofen "Ibuprofen"), [naproxen](https://en.wikipedia.org/wiki/Naproxen "Naproxen"), [mefenamic acid](https://en.wikipedia.org/wiki/Mefenamic_acid "Mefenamic acid")), [antiplatelet drugs](https://en.wikipedia.org/wiki/Antiplatelet_drug "Antiplatelet drug"), [anticoagulants](https://en.wikipedia.org/wiki/Anticoagulant "Anticoagulant"), [omega-3 fatty acids](https://en.wikipedia.org/wiki/Omega-3_fatty_acid "Omega-3 fatty acid"), [vitamin E](https://en.wikipedia.org/wiki/Vitamin_E "Vitamin E"), and garlic [supplements](https://en.wikipedia.org/wiki/Dietary_supplement "Dietary supplement") due to sertraline's inhibitory effects on [platelet aggregation](https://en.wikipedia.org/wiki/Platelet_aggregation "Platelet aggregation") via blocking [serotonin transporters](https://en.wikipedia.org/wiki/Serotonin_transporter "Serotonin transporter") on platelets.[\[115\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-115) Sertraline, in particular, may potentially diminish the efficacy of [levothyroxine](https://en.wikipedia.org/wiki/Levothyroxine "Levothyroxine").[\[116\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-116) Sertraline is a moderate [inhibitor](https://en.wikipedia.org/wiki/Enzyme_inhibitor "Enzyme inhibitor") of [CYP2D6](https://en.wikipedia.org/wiki/CYP2D6 "CYP2D6") and [CYP2B6](https://en.wikipedia.org/wiki/CYP2B6 "CYP2B6") *[in vitro](https://en.wikipedia.org/wiki/In_vitro "In vitro")*.[\[7\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16192315-7) Accordingly, in human trials it caused increased blood levels of CYP2D6 [substrates](https://en.wikipedia.org/wiki/Substrate_\(biochemistry\) "Substrate (biochemistry)") such as [metoprolol](https://en.wikipedia.org/wiki/Metoprolol "Metoprolol"), [dextromethorphan](https://en.wikipedia.org/wiki/Dextromethorphan "Dextromethorphan"), [desipramine](https://en.wikipedia.org/wiki/Desipramine "Desipramine"), [imipramine](https://en.wikipedia.org/wiki/Imipramine "Imipramine") and [nortriptyline](https://en.wikipedia.org/wiki/Nortriptyline "Nortriptyline"), as well as the [CYP3A4](https://en.wikipedia.org/wiki/CYP3A4 "CYP3A4")/CYP2D6 substrate [haloperidol](https://en.wikipedia.org/wiki/Haloperidol "Haloperidol").[\[117\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9472843-117)[\[118\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid10211917-118)[\[119\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid10631623-119) This effect is dose-dependent; for example, co-administration with 50 mg of sertraline resulted in 20% greater exposure to desipramine, while 150 mg of sertraline led to a 70% increase.[\[8\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12452737-8)[\[120\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid17224709-120) In a placebo-controlled study, the concomitant administration of sertraline and [methadone](https://en.wikipedia.org/wiki/Methadone "Methadone") caused a 40% increase in blood levels of the latter, which is primarily metabolized by CYP2B6.[\[121\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid10914294-121) [Bupropion](https://en.wikipedia.org/wiki/Bupropion "Bupropion") is metabolized by CYP2B6, which is inhibited by sertraline, and this may result in an interaction between sertraline and bupropion.[\[122\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-TurpeinenZanger2012-122)[\[123\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-SchatzbergHemeroff2024-123)[\[124\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-MolnariHassanMyers2012-124) Sertraline had a slight inhibitory effect on the metabolism of [diazepam](https://en.wikipedia.org/wiki/Diazepam "Diazepam"), [tolbutamide](https://en.wikipedia.org/wiki/Tolbutamide "Tolbutamide"), and [warfarin](https://en.wikipedia.org/wiki/Warfarin "Warfarin"), which are [CYP2C9](https://en.wikipedia.org/wiki/CYP2C9 "CYP2C9") or [CYP2C19](https://en.wikipedia.org/wiki/CYP2C19 "CYP2C19") substrates; the clinical relevance of this effect was unclear.[\[8\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12452737-8) As expected from *in vitro* data, sertraline did not alter the human metabolism of the CYP3A4 substrates [erythromycin](https://en.wikipedia.org/wiki/Erythromycin "Erythromycin"), [alprazolam](https://en.wikipedia.org/wiki/Alprazolam "Alprazolam"), [carbamazepine](https://en.wikipedia.org/wiki/Carbamazepine "Carbamazepine"), [clonazepam](https://en.wikipedia.org/wiki/Clonazepam "Clonazepam"), and [terfenadine](https://en.wikipedia.org/wiki/Terfenadine "Terfenadine"); neither did it affect metabolism of the [CYP1A2](https://en.wikipedia.org/wiki/CYP1A2 "CYP1A2") substrate [clozapine](https://en.wikipedia.org/wiki/Clozapine "Clozapine").[\[8\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12452737-8)[\[23\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-DailyMed-23)[\[125\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid14709940-125)[\[7\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16192315-7) Sertraline did not affect the actions of [digoxin](https://en.wikipedia.org/wiki/Digoxin "Digoxin") and [atenolol](https://en.wikipedia.org/wiki/Atenolol "Atenolol"), which are not metabolized in the liver.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) [Case reports](https://en.wikipedia.org/wiki/Case_report "Case report") suggest that taking sertraline with [phenytoin](https://en.wikipedia.org/wiki/Phenytoin "Phenytoin") or [zolpidem](https://en.wikipedia.org/wiki/Zolpidem "Zolpidem") may induce sertraline metabolism and decrease its efficacy,[\[126\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-126)[\[127\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-127) and that taking sertraline with [lamotrigine](https://en.wikipedia.org/wiki/Lamotrigine "Lamotrigine") may increase the blood level of lamotrigine, possibly by inhibition of glucuronidation.[\[128\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9627209-128) CYP2C19 inhibitor [esomeprazole](https://en.wikipedia.org/wiki/Esomeprazole "Esomeprazole") increased sertraline concentrations in blood plasma by approximately 40%.[\[129\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid24887634-129) Clinical reports indicate that interaction between sertraline and the [MAOIs](https://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor "Monoamine oxidase inhibitor") [isocarboxazid](https://en.wikipedia.org/wiki/Isocarboxazid "Isocarboxazid") and [tranylcypromine](https://en.wikipedia.org/wiki/Tranylcypromine "Tranylcypromine") may cause [serotonin syndrome](https://en.wikipedia.org/wiki/Serotonin_syndrome "Serotonin syndrome"). In a placebo-controlled study in which sertraline was co-administered with [lithium](https://en.wikipedia.org/wiki/Lithium_pharmacology "Lithium pharmacology"), 35% of the subjects experienced tremors, while none of those taking placebo did.[\[8\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12452737-8) ## Pharmacology \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=18 "Edit section: Pharmacology")\] ### Pharmacodynamics \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=19 "Edit section: Pharmacodynamics")\] | Site | *K*i (nM) | Species | References | |---|---|---|---| | [SERT](https://en.wikipedia.org/wiki/Serotonin_transporter "Serotonin transporter")Tooltip Serotonin transporter | 0\.15–3.3 | Human | [\[131\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9537821-131)[\[132\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9400006-132)[\[133\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11543737-133) | | [NET](https://en.wikipedia.org/wiki/Norepinephrine_transporter "Norepinephrine transporter")Tooltip Norepinephrine transporter | 420–925 | Human | [\[131\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9537821-131)[\[132\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9400006-132)[\[133\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11543737-133) | | [DAT](https://en.wikipedia.org/wiki/Dopamine_transporter "Dopamine transporter")Tooltip Dopamine transporter | 22–315 | Human | [\[131\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9537821-131)[\[132\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9400006-132)[\[133\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11543737-133) | | [5-HT1A](https://en.wikipedia.org/wiki/5-HT1A_receptor "5-HT1A receptor") | 35000+ | Human | [\[134\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid7855217-134) | | [5-HT2A](https://en.wikipedia.org/wiki/5-HT2A_receptor "5-HT2A receptor") | 2207 | Rat | [\[133\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11543737-133) | | [5-HT2C](https://en.wikipedia.org/wiki/5-HT2C_receptor "5-HT2C receptor") | 2298 | Pig | [\[133\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11543737-133) | | [α1A](https://en.wikipedia.org/wiki/Alpha-1A_adrenergic_receptor "Alpha-1A adrenergic receptor") | 1900 | Human | [\[135\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid32608144-135) | | [α1B](https://en.wikipedia.org/wiki/Alpha-1B_adrenergic_receptor "Alpha-1B adrenergic receptor") | 3500 | Human | [\[135\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid32608144-135) | | [α1D](https://en.wikipedia.org/wiki/Alpha-1D_adrenergic_receptor "Alpha-1D adrenergic receptor") | 2500 | Human | [\[135\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid32608144-135) | | [α2](https://en.wikipedia.org/wiki/Alpha-2_adrenergic_receptor "Alpha-2 adrenergic receptor") | 477–4100 | Human | [\[132\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9400006-132)[\[134\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid7855217-134) | | [D2](https://en.wikipedia.org/wiki/D2_receptor "D2 receptor") | 10700 | Human | [\[134\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid7855217-134) | | [H1](https://en.wikipedia.org/wiki/Histamine_H1_receptor "Histamine H1 receptor") | 24000 | Human | [\[134\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid7855217-134) | | [mACh](https://en.wikipedia.org/wiki/Muscarinic_acetylcholine_receptors "Muscarinic acetylcholine receptors")Tooltip Muscarinic acetylcholine receptors | 427–2100 | Human | [\[133\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11543737-133)[\[134\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid7855217-134)[\[136\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid8100134-136) | | [σ1](https://en.wikipedia.org/wiki/Sigma-1_receptor "Sigma-1 receptor") | 32–57 | Rat | [\[137\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-AlbayrakHashimoto2017-137)[\[138\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid20373470-138) | | [σ2](https://en.wikipedia.org/wiki/Sigma-2_receptor "Sigma-2 receptor") | 5297 | Rat | [\[138\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid20373470-138) | | Values are *K*i (nM), unless otherwise noted. The smaller the value, the more strongly the drug binds to or inhibits the site. | | | | Sertraline is a [selective serotonin reuptake inhibitor](https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor "Selective serotonin reuptake inhibitor") (SSRI). By binding to the [serotonin transporter](https://en.wikipedia.org/wiki/Serotonin_transporter "Serotonin transporter") (SERT) it inhibits neuronal [reuptake](https://en.wikipedia.org/wiki/Reuptake "Reuptake") of [serotonin](https://en.wikipedia.org/wiki/Serotonin "Serotonin") and potentiates serotonergic activity in the [central nervous system](https://en.wikipedia.org/wiki/Central_nervous_system "Central nervous system").[\[23\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-DailyMed-23) Over time, this leads to a downregulation of pre-synaptic [5-HT1A](https://en.wikipedia.org/wiki/5-HT1A_receptor "5-HT1A receptor") receptors, which is associated with an improvement in passive stress tolerance, and delayed downstream increase in expression of [brain-derived neurotrophic factor](https://en.wikipedia.org/wiki/Brain-derived_neurotrophic_factor "Brain-derived neurotrophic factor") (BDNF), which may contribute to a reduction in negative affective biases.[\[139\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-139)[\[140\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-140) It does not significantly affect [histamine](https://en.wikipedia.org/wiki/Histamine_receptor "Histamine receptor"), [acetylcholine](https://en.wikipedia.org/wiki/Acetylcholine_receptor "Acetylcholine receptor"), [GABA](https://en.wikipedia.org/wiki/GABA_receptor "GABA receptor") or [benzodiazepine](https://en.wikipedia.org/wiki/Benzodiazepine "Benzodiazepine") receptors.[\[23\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-DailyMed-23) Sertraline also shows relatively high activity as an inhibitor of the [dopamine transporter](https://en.wikipedia.org/wiki/Dopamine_transporter "Dopamine transporter") (DAT) occupying ~20% of DAT receptors at doses 200mg and above,[\[131\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9537821-131)[\[141\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11357798-141)[\[142\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-HemmingsEgan2012-142) and antagonist of the [sigma](https://en.wikipedia.org/wiki/Sigma_receptor "Sigma receptor") [σ1 receptor](https://en.wikipedia.org/wiki/Sigma-1_receptor "Sigma-1 receptor") (but not the [σ2 receptor](https://en.wikipedia.org/wiki/Sigma-2_receptor "Sigma-2 receptor")).[\[137\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-AlbayrakHashimoto2017-137)[\[138\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid20373470-138)[\[143\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid20021354-143) However, sertraline affinity for its main target (SERT) is much greater than its affinity for σ1 receptor and DAT.[\[130\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-PDSP-130)[\[131\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9537821-131)[\[138\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid20373470-138)[\[137\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-AlbayrakHashimoto2017-137) Although there could be a role for the σ1 receptor in the [pharmacology](https://en.wikipedia.org/wiki/Pharmacology "Pharmacology") of sertraline, the significance of this receptor in its actions is unclear.[\[34\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11420570-34) Similarly, the clinical relevance of sertraline's blockade of the dopamine transporter is uncertain.[\[131\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9537821-131) Sertraline is a REDD1-dependent [mTOR inhibitor](https://en.wikipedia.org/wiki/MTOR_inhibitors "MTOR inhibitors"). It blocks [AKT](https://en.wikipedia.org/wiki/Protein_kinase_B "Protein kinase B")/mTOR pathway and has [autophagy](https://en.wikipedia.org/wiki/Autophagy "Autophagy")\-inducing activity.[\[144\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-144)[\[145\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-145)[\[146\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-146)[\[147\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-147) ### Pharmacokinetics \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=20 "Edit section: Pharmacokinetics")\] [![](https://upload.wikimedia.org/wikipedia/commons/thumb/b/bf/Desmethylsertraline_skeletal.svg/250px-Desmethylsertraline_skeletal.svg.png)](https://en.wikipedia.org/wiki/File:Desmethylsertraline_skeletal.svg) [Desmethylsertraline](https://en.wikipedia.org/wiki/Desmethylsertraline "Desmethylsertraline"), the major [metabolite](https://en.wikipedia.org/wiki/Metabolite "Metabolite") of sertraline #### Absorption \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=21 "Edit section: Absorption")\] Following a single oral dose of sertraline, mean peak blood levels of sertraline occur between 4.5 and 8.4 hours.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) [Bioavailability](https://en.wikipedia.org/wiki/Bioavailability "Bioavailability") is likely linear and dose-proportional over a dose range of 150 to 200 mg.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) Concomitant intake of sertraline with food slightly increases sertraline peak levels and total exposure.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) There is an approximate 2-fold accumulation of sertraline with continuous administration and [steady-state levels](https://en.wikipedia.org/wiki/Steady_state_\(pharmacokinetics\) "Steady state (pharmacokinetics)") are reached within one week.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) #### Distribution \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=22 "Edit section: Distribution")\] Sertraline is highly [plasma protein bound](https://en.wikipedia.org/wiki/Plasma_protein_binding "Plasma protein binding") (98.5%) across a concentration range of 20 to 500 ng/mL.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) Despite the high plasma protein binding, sertraline and its [metabolite](https://en.wikipedia.org/wiki/Metabolite "Metabolite") [desmethylsertraline](https://en.wikipedia.org/wiki/Desmethylsertraline "Desmethylsertraline") at respective tested concentrations of 300 ng/mL and 200 ng/mL were found not to interfere with the plasma protein binding of [warfarin](https://en.wikipedia.org/wiki/Warfarin "Warfarin") and [propranolol](https://en.wikipedia.org/wiki/Propranolol "Propranolol"), two other highly plasma protein-bound drugs.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) #### Metabolism \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=23 "Edit section: Metabolism")\] Sertraline is subject to extensive [first-pass metabolism](https://en.wikipedia.org/wiki/First-pass_metabolism "First-pass metabolism"), as indicated by a small study of [radiolabeled](https://en.wikipedia.org/wiki/Radiolabel "Radiolabel") sertraline in which less than 5% of plasma [radioactivity](https://en.wikipedia.org/wiki/Radioactivity "Radioactivity") was unchanged sertraline in two males.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) The principal [metabolic pathway](https://en.wikipedia.org/wiki/Metabolic_pathway "Metabolic pathway") for sertraline is [*N*\-demethylation](https://en.wikipedia.org/wiki/Demethylation "Demethylation") into [desmethylsertraline](https://en.wikipedia.org/wiki/Desmethylsertraline "Desmethylsertraline") (*N*\-desmethylsertraline) mainly by [CYP2B6](https://en.wikipedia.org/wiki/CYP2B6 "CYP2B6").[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5)[\[9\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid15547048-9) [Reduction](https://en.wikipedia.org/wiki/Redox "Redox"), [hydroxylation](https://en.wikipedia.org/wiki/Hydroxylation "Hydroxylation"), and [glucuronide](https://en.wikipedia.org/wiki/Glucuronidation "Glucuronidation") [conjugation](https://en.wikipedia.org/wiki/Conjugation_\(biochemistry\) "Conjugation (biochemistry)") of both sertraline and desmethylsertraline also occur.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) Desmethylsertraline, while [pharmacologically active](https://en.wikipedia.org/wiki/Pharmacologically_active "Pharmacologically active"), is substantially (50-fold) weaker than sertraline as a [serotonin reuptake inhibitor](https://en.wikipedia.org/wiki/Serotonin_reuptake_inhibitor "Serotonin reuptake inhibitor") and its influence on the clinical effects of sertraline is thought to be negligible.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5)[\[132\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9400006-132)[\[148\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-In_Vivo_SERT_binding-148) Based on *[in vitro](https://en.wikipedia.org/wiki/In_vitro "In vitro")* studies, sertraline is [metabolized](https://en.wikipedia.org/wiki/Metabolism "Metabolism") by multiple [cytochrome 450](https://en.wikipedia.org/wiki/Cytochrome_450 "Cytochrome 450") [isoforms](https://en.wikipedia.org/wiki/Isoenzyme "Isoenzyme");[\[9\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid15547048-9)[\[149\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid10383917-149) however, it appears that in the human body [CYP2C19](https://en.wikipedia.org/wiki/CYP2C19 "CYP2C19") plays the most important role, followed by [CYP2B6](https://en.wikipedia.org/wiki/CYP2B6 "CYP2B6").[\[150\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid29136336-150) In addition to the cytochrome P450 system, sertraline can be [oxidatively](https://en.wikipedia.org/wiki/Oxidation "Oxidation") [deaminated](https://en.wikipedia.org/wiki/Deamination "Deamination") *[in vitro](https://en.wikipedia.org/wiki/In_vitro "In vitro")* by [monoamine oxidases](https://en.wikipedia.org/wiki/Monoamine_oxidase "Monoamine oxidase");[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) however, this [metabolic pathway](https://en.wikipedia.org/wiki/Metabolic_pathway "Metabolic pathway") has never been studied *[in vivo](https://en.wikipedia.org/wiki/In_vivo "In vivo")*.[\[9\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid15547048-9) #### Elimination \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=24 "Edit section: Elimination")\] The [elimination half-life](https://en.wikipedia.org/wiki/Elimination_half-life "Elimination half-life") of sertraline is on average 26 hours, with a range of 13 to 45 hours.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5)[\[8\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12452737-8) The elimination half-life of desmethylsertraline is 62 to 104 hours.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) In a small study of two people, sertraline was [excreted](https://en.wikipedia.org/wiki/Excretion "Excretion") to similar degrees in [urine](https://en.wikipedia.org/wiki/Urine "Urine") and [feces](https://en.wikipedia.org/wiki/Feces "Feces") (40 to 45% each within 9 days).[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) Unchanged sertraline was not detectable in urine, whereas 12 to 14% of unchanged sertraline was present in feces.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) ### Pharmacogenomics \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=25 "Edit section: Pharmacogenomics")\] [CYP2C19](https://en.wikipedia.org/wiki/CYP2C19 "CYP2C19") and [CYP2B6](https://en.wikipedia.org/wiki/CYP2B6 "CYP2B6") are thought to be the key [cytochrome P450](https://en.wikipedia.org/wiki/Cytochrome_P450 "Cytochrome P450") [enzymes](https://en.wikipedia.org/wiki/Enzyme "Enzyme") involved in the [metabolism](https://en.wikipedia.org/wiki/Metabolism "Metabolism") of sertraline.[\[150\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid29136336-150) Relative to CYP2C19 [normal (extensive) metabolizers](https://en.wikipedia.org/wiki/Extensive_metabolizer "Extensive metabolizer"), [poor metabolizers](https://en.wikipedia.org/wiki/Poor_metabolizer "Poor metabolizer") have 2.7-fold higher levels of sertraline[\[151\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid31649299-151) and [intermediate metabolizers](https://en.wikipedia.org/wiki/Intermediate_metabolizer "Intermediate metabolizer") have 1.4-fold higher levels.[\[152\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid33237321-152) In contrast, CYP2B6 poor metabolizers have 1.6-fold higher levels of sertraline and intermediate metabolizers have 1.2-fold higher levels.[\[150\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid29136336-150) ## Chemistry \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=26 "Edit section: Chemistry")\] In terms of [chemical structure](https://en.wikipedia.org/wiki/Chemical_structure "Chemical structure"), sertraline is a [1-aminotetralin](https://en.wikipedia.org/wiki/1-aminotetralin "1-aminotetralin").[\[153\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Kachhadiya_2025-153) Several notable [analogues](https://en.wikipedia.org/wiki/Structural_analog "Structural analog") sertraline are known, including [desmethylsertraline](https://en.wikipedia.org/wiki/Desmethylsertraline "Desmethylsertraline"), [dasotraline](https://en.wikipedia.org/wiki/Dasotraline "Dasotraline"), [tametraline](https://en.wikipedia.org/wiki/Tametraline "Tametraline"), and [lometraline](https://en.wikipedia.org/wiki/Lometraline "Lometraline").[\[153\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Kachhadiya_2025-153) ## History \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=27 "Edit section: History")\] [![](https://upload.wikimedia.org/wikipedia/commons/thumb/0/07/Sertraline_precursors.svg/500px-Sertraline_precursors.svg.png)](https://en.wikipedia.org/wiki/File:Sertraline_precursors.svg) [Skeletal formulae](https://en.wikipedia.org/wiki/Skeletal_formula "Skeletal formula") of thiothixene, lometraline and tametraline, from which sertraline was derived. Commonalities to the structure of sertraline are highlighted in red. The history of sertraline dates back to the early 1970s when [Pfizer](https://en.wikipedia.org/wiki/Pfizer "Pfizer") chemist Reinhard Sarges invented a novel series of psychoactive compounds, including [lometraline](https://en.wikipedia.org/wiki/Lometraline "Lometraline"), based on the structures of the neuroleptics [thiothixene](https://en.wikipedia.org/wiki/Thiothixene "Thiothixene") and [pinoxepin](https://en.wikipedia.org/wiki/Pinoxepin "Pinoxepin").[\[154\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Welch-154)[\[155\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-155) Further work on these compounds led to [tametraline](https://en.wikipedia.org/wiki/Tametraline "Tametraline"), a [norepinephrine](https://en.wikipedia.org/wiki/Norepinephrine_reuptake_inhibitor "Norepinephrine reuptake inhibitor") and weaker [dopamine reuptake inhibitor](https://en.wikipedia.org/wiki/Dopamine_reuptake_inhibitor "Dopamine reuptake inhibitor"). Development of tametraline was soon stopped because of undesired [stimulant](https://en.wikipedia.org/wiki/Stimulant "Stimulant") effects observed in animals. A few years later, in 1977, pharmacologist [Kenneth Koe](https://en.wikipedia.org/wiki/Kenneth_Koe "Kenneth Koe"), after comparing the structural features of a variety of reuptake inhibitors, became interested in the tametraline series. He asked another Pfizer chemist, Willard Welch, to synthesize some previously unexplored tametraline derivatives. Welch generated several potent norepinephrine and [triple reuptake](https://en.wikipedia.org/wiki/Serotonin-noradrenaline-dopamine_reuptake_inhibitor "Serotonin-noradrenaline-dopamine reuptake inhibitor") inhibitors, but to the surprise of the scientists, one representative of the generally inactive [cis-analogs](https://en.wikipedia.org/wiki/Cis-trans_isomerism "Cis-trans isomerism") was a serotonin reuptake inhibitor. Welch then prepared [stereoisomers](https://en.wikipedia.org/wiki/Stereoisomerism "Stereoisomerism") of this compound, which were tested *[in vivo](https://en.wikipedia.org/wiki/In_vivo "In vivo")* by animal [behavioral scientist](https://en.wikipedia.org/wiki/Behavioural_sciences "Behavioural sciences") Albert Weissman. The most potent and selective (+)-isomer[\[a\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-158) was taken into further development and eventually named sertraline. Weissman and Koe recalled that the group did not set up to produce an antidepressant of the SSRI type—in that sense their inquiry was not "very goal driven", and the invention of the sertraline molecule was [serendipitous](https://en.wikipedia.org/wiki/Serendipity#Pharmacology "Serendipity"). According to Welch, they worked outside the mainstream at Pfizer, and even "did not have a formal project team". The group had to overcome initial bureaucratic reluctance to pursue sertraline development, as Pfizer was considering licensing an antidepressant candidate from another company.[\[154\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Welch-154)[\[158\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-159)[\[159\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-160) Sertraline was approved by the US [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) in 1991 based on the recommendation of the Psychopharmacological Drugs Advisory Committee; it had already become available in the [United Kingdom](https://en.wikipedia.org/wiki/United_Kingdom "United Kingdom") the previous year.[\[160\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-He168-161) The FDA committee achieved a consensus that sertraline was safe and effective for the treatment of [major depression](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder"). During the discussion, Paul Leber, the director of the FDA Division of Neuropharmacological Drug Products, noted that granting approval was a "tough decision", since the treatment effect on [outpatients](https://en.wikipedia.org/wiki/Patient#Outpatient_vs_inpatientOutpatients_and_inpatients "Patient") with depression had been "modest to minimal". Other experts emphasized that the drug's effect on inpatients had not differed from [placebo](https://en.wikipedia.org/wiki/Placebo "Placebo") and criticized the poor design of the clinical trials by Pfizer.[\[161\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pdac-162) For example, 40% of participants dropped out of the trials, significantly decreasing their [validity](https://en.wikipedia.org/wiki/Validity_\(statistics\) "Validity (statistics)").[\[162\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid8573661-163) Until 2002, sertraline was only approved for use in adults ages 18 and over; that year, it was approved by the FDA for use in treating children aged 6 or older with severe OCD. In 2003, the UK [Medicines and Healthcare products Regulatory Agency](https://en.wikipedia.org/wiki/Medicines_and_Healthcare_products_Regulatory_Agency "Medicines and Healthcare products Regulatory Agency") issued guidance that, apart from [fluoxetine](https://en.wikipedia.org/wiki/Fluoxetine "Fluoxetine") (Prozac), SSRIs are not suitable for the treatment of depression in patients under 18.[\[163\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-164)[\[164\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-165) However, sertraline can still be used in the UK for the treatment of OCD in children and adolescents.[\[165\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-166) In 2005, the FDA added a [boxed warning](https://en.wikipedia.org/wiki/Boxed_warning "Boxed warning") concerning pediatric suicidal behavior to all [antidepressants](https://en.wikipedia.org/wiki/Antidepressant "Antidepressant"), including sertraline. In 2007, labeling was again changed to add a warning regarding suicidal behavior in young adults ages 18 to 24.[\[166\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-167) ## Society and culture \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=28 "Edit section: Society and culture")\] ### Generic availability \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=29 "Edit section: Generic availability")\] The US patent for Zoloft expired in 2006,[\[167\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-168) and sertraline is available in [generic](https://en.wikipedia.org/wiki/Generic_drug "Generic drug") form and is marketed under many brand names worldwide.[\[1\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Brand2015-1) ### Brand names \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=30 "Edit section: Brand names")\] In the US, Zoloft is marketed by [Viatris](https://en.wikipedia.org/wiki/Viatris "Viatris") after Upjohn was spun off from Pfizer.[\[168\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-169)[\[169\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-170)[\[170\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-171) ### Interest during COVID-19 pandemic \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=31 "Edit section: Interest during COVID-19 pandemic")\] Sertraline has been the most sought-after antidepressant worldwide before, during, and after the [COVID-19 pandemic](https://en.wikipedia.org/wiki/COVID-19_pandemic "COVID-19 pandemic"), according to [Google Trends](https://en.wikipedia.org/wiki/Google_Trends "Google Trends") data. The pandemic has led to an increase in searches for antidepressants, with sertraline, [fluoxetine](https://en.wikipedia.org/wiki/Fluoxetine "Fluoxetine"), [duloxetine](https://en.wikipedia.org/wiki/Duloxetine "Duloxetine"), and [venlafaxine](https://en.wikipedia.org/wiki/Venlafaxine "Venlafaxine") showing the highest search volumes, whereas searches of [citalopram](https://en.wikipedia.org/wiki/Citalopram "Citalopram") decreased during the pandemic.[\[171\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid37731683-172) ## Research \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=32 "Edit section: Research")\] Sertraline may be useful to treat [murine Zaire ebolavirus](https://en.wikipedia.org/wiki/Murine_Zaire_ebolavirus "Murine Zaire ebolavirus") (murine EBOV).[\[172\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Ebola-treatment-173) The [World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization") (WHO) considers this a promising area of research.[\[172\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Ebola-treatment-173) Lass-Flörl *et al.*, 2003 finds it significantly inhibits [phospholipase B](https://en.wikipedia.org/wiki/Phospholipase_B "Phospholipase B") in the fungal genus *[Candida](https://en.wikipedia.org/wiki/Candida_\(fungus\) "Candida (fungus)")*, reducing [virulence](https://en.wikipedia.org/wiki/Virulence "Virulence").[\[173\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Phospholipase-B-174) Sertraline is also a very effective leishmanicide.[\[174\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Chamber-of-Secrets-175) Specifically, Palit & Ali 2008 find that sertraline kills almost all [promastigotes](https://en.wikipedia.org/wiki/Promastigote "Promastigote") of *[Leishmania donovani](https://en.wikipedia.org/wiki/Leishmania_donovani "Leishmania donovani")*.[\[174\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Chamber-of-Secrets-175) Sertraline is strongly [antibacterial](https://en.wikipedia.org/wiki/Antibacterial "Antibacterial") against some species.[\[174\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Chamber-of-Secrets-175) It is also known to act as a [photosensitizer](https://en.wikipedia.org/wiki/Photosensitizer "Photosensitizer") of bacterial surfaces.[\[175\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Photosensitizers-176) In combination with antibacterials its photosensitization effect reverses [antibacterial resistance](https://en.wikipedia.org/wiki/Antibacterial_resistance "Antibacterial resistance").[\[175\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Photosensitizers-176) As such sertraline shows promise for [food preservation](https://en.wikipedia.org/wiki/Food_preservation "Food preservation").[\[175\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Photosensitizers-176) Lass-Flörl *et al.*, 2003 finds this compound acts as a [fungicide](https://en.wikipedia.org/wiki/Fungicide "Fungicide") against *[Candida parapsilosis](https://en.wikipedia.org/wiki/Candida_parapsilosis "Candida parapsilosis")*.[\[176\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Immunomodulation-177) Its anti-*Cp* effect is indeed due to its [serotonergic](https://en.wikipedia.org/wiki/Serotonin "Serotonin") activity and not its other effects.[\[176\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Immunomodulation-177) Sertraline is a promising [trypanocide](https://en.wikipedia.org/wiki/Trypanocide "Trypanocide").[\[177\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-tcruz-178) It acts at several different [life stages](https://en.wikipedia.org/wiki/Trypanosoma#Hosts,_life_cycle_and_morphologies "Trypanosoma") and against several [strains](https://en.wikipedia.org/wiki/Strain_\(biology\) "Strain (biology)").[\[177\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-tcruz-178) Sertraline's trypanocidal [mechanism of action](https://en.wikipedia.org/wiki/Mechanism_of_action "Mechanism of action") is by way of interference with [bioenergetics](https://en.wikipedia.org/wiki/Bioenergetics "Bioenergetics").[\[177\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-tcruz-178) When mothers take sertraline during pregnancy, there is research evidence that the newborn may experience sertraline withdrawal symptoms.[\[178\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-179) ## See also \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=33 "Edit section: See also")\] - [List of antidepressants](https://en.wikipedia.org/wiki/List_of_antidepressants "List of antidepressants") ## References \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=34 "Edit section: References")\] 1. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-158)** Also known as "*cis*\-(1S,4S)". Out of all four possible enantiomers, *cis*\-(1R,4R) is also active on the serotonin transporter,[\[156\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-156) and *trans*\-(1R,4S) is an [SNDRI](https://en.wikipedia.org/wiki/SNDRI "SNDRI")[\[157\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-157). 1. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Brand2015_1-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Brand2015_1-1) ["Sertraline international"](https://www.drugs.com/international/sertraline.html). *Drugs.com*. Retrieved 11 May 2015. 2. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Drugs.com_pregnancy_2-0)** ["Sertraline (Zoloft) Use During Pregnancy"](https://www.drugs.com/pregnancy/sertraline.html). *Drugs.com*. 4 May 2020. Retrieved 17 May 2020. 3. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Hub2001_3-0)** Hubbard JR, Martin PR (2001). [*Substance Abuse in the Mentally and Physically Disabled*](https://books.google.com/books?id=MY1kFYk98mQC&pg=PA26). CRC Press. p. 26. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-8247-4497-7](https://en.wikipedia.org/wiki/Special:BookSources/978-0-8247-4497-7 "Special:BookSources/978-0-8247-4497-7") . 4. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-4)** [Anvisa](https://en.wikipedia.org/wiki/Brazilian_Health_Regulatory_Agency "Brazilian Health Regulatory Agency") (31 March 2023). ["RDC NÂș 784 - Listas de SubstĂąncias Entorpecentes, PsicotrĂłpicas, Precursoras e Outras sob Controle Especial"](https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-784-de-31-de-marco-de-2023-474904992) \[Collegiate Board Resolution No. 784 - Lists of Narcotic, Psychotropic, Precursor, and Other Substances under Special Control\] (in Brazilian Portuguese). [DiĂĄrio Oficial da UniĂŁo](https://en.wikipedia.org/wiki/Di%C3%A1rio_Oficial_da_Uni%C3%A3o "DiĂĄrio Oficial da UniĂŁo") (published 4 April 2023). [Archived](https://web.archive.org/web/20230803143925/https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-784-de-31-de-marco-de-2023-474904992) from the original on 3 August 2023. Retrieved 16 August 2023. 5. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-1) [***c***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-2) [***d***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-3) [***e***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-4) [***f***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-5) [***g***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-6) [***h***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-7) [***i***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-8) [***j***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-9) [***k***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-10) [***l***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-11) [***m***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-12) [***n***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-13) [***o***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-14) [***p***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-15) [***q***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-16) [***r***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-17) [***s***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-18) [***t***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-19) [***u***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-20) [***v***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-21) [Sertraline FDA Label](https://web.archive.org/web/20160625120717/http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/019839s084,020990s043lbl.pdf) Last updated May 2014 6. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-GG_6-0)** Brunton L, Chabner B, Knollman B (2010). *Goodman and Gilman's The Pharmacological Basis of Therapeutics* (Twelfth ed.). McGraw Hill Professional. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-07-176939-6](https://en.wikipedia.org/wiki/Special:BookSources/978-0-07-176939-6 "Special:BookSources/978-0-07-176939-6") . 7. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid16192315_7-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid16192315_7-1) [***c***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid16192315_7-2) Obach RS, Walsky RL, Venkatakrishnan K, Gaman EA, Houston JB, Tremaine LM (January 2006). "The utility of in vitro cytochrome P450 inhibition data in the prediction of drug–drug interactions". *The Journal of Pharmacology and Experimental Therapeutics*. **316** (1): 336–48\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1124/jpet.105.093229](https://doi.org/10.1124%2Fjpet.105.093229). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [16192315](https://pubmed.ncbi.nlm.nih.gov/16192315). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [12975686](https://api.semanticscholar.org/CorpusID:12975686). 8. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid12452737_8-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid12452737_8-1) [***c***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid12452737_8-2) [***d***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid12452737_8-3) [***e***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid12452737_8-4) [***f***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid12452737_8-5) DeVane CL, Liston HL, Markowitz JS (2002). "Clinical pharmacokinetics of sertraline". *Clin Pharmacokinet*. **41** (15): 1247–66\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.2165/00003088-200241150-00002](https://doi.org/10.2165%2F00003088-200241150-00002). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [12452737](https://pubmed.ncbi.nlm.nih.gov/12452737). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [28720641](https://api.semanticscholar.org/CorpusID:28720641). 9. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid15547048_9-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid15547048_9-1) [***c***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid15547048_9-2) [***d***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid15547048_9-3) Obach RS, Cox LM, Tremaine LM (February 2005). "Sertraline is metabolized by multiple cytochrome P450 enzymes, monoamine oxidases, and glucuronyl transferases in human: an in vitro study". *Drug Metabolism and Disposition*. **33** (2): 262–70\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1124/dmd.104.002428](https://doi.org/10.1124%2Fdmd.104.002428). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [15547048](https://pubmed.ncbi.nlm.nih.gov/15547048). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [7254643](https://api.semanticscholar.org/CorpusID:7254643). 10. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-AHFS2018_10-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-AHFS2018_10-1) ["Sertraline Hydrochloride"](https://www.drugs.com/monograph/sertraline-hydrochloride.html). *Drugs.com*. The American Society of Health-System Pharmacists. 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["Selective serotonin reuptake inhibitor use during early pregnancy and congenital malformations: a systematic review and meta-analysis of cohort studies of more than 9 million births"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231277). *BMC Med*. **16** (1) 205. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1186/s12916-018-1193-5](https://doi.org/10.1186%2Fs12916-018-1193-5). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6231277](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231277). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [30415641](https://pubmed.ncbi.nlm.nih.gov/30415641). 17. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid33354752_17-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid33354752_17-1) De Vries C, Gadzhanova S, Sykes MJ, Ward M, Roughead E (March 2021). ["A Systematic Review and Meta-Analysis Considering the Risk for Congenital Heart Defects of Antidepressant Classes and Individual Antidepressants"](https://unisa.alma.exlibrisgroup.com/view/delivery/61USOUTHAUS_INST/12212569530001831). *Drug Saf*. **44** (3): 291–312\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s40264-020-01027-x](https://doi.org/10.1007%2Fs40264-020-01027-x). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [0114-5916](https://search.worldcat.org/issn/0114-5916). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [33354752](https://pubmed.ncbi.nlm.nih.gov/33354752). 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[PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [8100134](https://pubmed.ncbi.nlm.nih.gov/8100134). 137. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-AlbayrakHashimoto2017_137-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-AlbayrakHashimoto2017_137-1) [***c***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-AlbayrakHashimoto2017_137-2) Albayrak Y, Hashimoto K (2017). "Sigma-1 Receptor Agonists and Their Clinical Implications in Neuropsychiatric Disorders". *Sigma Receptors: Their Role in Disease and as Therapeutic Targets*. Advances in Experimental Medicine and Biology. Vol. 964. pp. 153–161\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/978-3-319-50174-1\_11](https://doi.org/10.1007%2F978-3-319-50174-1_11). [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-3-319-50172-7](https://en.wikipedia.org/wiki/Special:BookSources/978-3-319-50172-7 "Special:BookSources/978-3-319-50172-7") . [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28315270](https://pubmed.ncbi.nlm.nih.gov/28315270). 138. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid20373470_138-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid20373470_138-1) [***c***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid20373470_138-2) [***d***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid20373470_138-3) Hindmarch I, Hashimoto K (April 2010). "Cognition and depression: the effects of fluvoxamine, a sigma-1 receptor agonist, reconsidered". *Human Psychopharmacology*. **25** (3): 193–200\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/hup.1106](https://doi.org/10.1002%2Fhup.1106). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20373470](https://pubmed.ncbi.nlm.nih.gov/20373470). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [26491662](https://api.semanticscholar.org/CorpusID:26491662). 139. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-139)** Carhart-Harris RL, Nutt DJ (September 2017). ["Serotonin and brain function: a tale of two receptors"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5606297). *Journal of Psychopharmacology*. **31** (9): 1091–1120\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1177/0269881117725915](https://doi.org/10.1177%2F0269881117725915). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5606297](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5606297). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28858536](https://pubmed.ncbi.nlm.nih.gov/28858536). 140. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-140)** Harmer CJ, Duman RS, Cowen PJ (May 2017). ["How do antidepressants work? New perspectives for refining future treatment approaches"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410405). *The Lancet. Psychiatry*. **4** (5): 409–418\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S2215-0366(17)30015-9](https://doi.org/10.1016%2FS2215-0366%2817%2930015-9). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5410405](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410405). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28153641](https://pubmed.ncbi.nlm.nih.gov/28153641). 141. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid11357798_141-0)** Richelson E (May 2001). ["Pharmacology of antidepressants"](https://doi.org/10.4065%2F76.5.511). *Mayo Clinic Proceedings*. **76** (5): 511–27\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.4065/76.5.511](https://doi.org/10.4065%2F76.5.511). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [11357798](https://pubmed.ncbi.nlm.nih.gov/11357798). 142. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-HemmingsEgan2012_142-0)** Hemmings HC, Egan TD (2012). [*Pharmacology and Physiology for Anesthesia E-Book: Foundations and Clinical Application*](https://books.google.com/books?id=am_DS7rgypAC&pg=PA183). Elsevier Health Sciences. pp. 183–. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-1-4557-3793-2](https://en.wikipedia.org/wiki/Special:BookSources/978-1-4557-3793-2 "Special:BookSources/978-1-4557-3793-2") . 143. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid20021354_143-0)** Hashimoto K (September 2009). "Sigma-1 receptors and selective serotonin reuptake inhibitors: clinical implications of their relationship". *Central Nervous System Agents in Medicinal Chemistry*. **9** (3): 197–204\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.2174/1871524910909030197](https://doi.org/10.2174%2F1871524910909030197). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20021354](https://pubmed.ncbi.nlm.nih.gov/20021354). 144. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-144)** Chen-Ju Lin, Francis Robert, Rami Sukarieh, Stephen Michnick, Jerry Pelletier (15 April 2010). "The antidepressant sertraline inhibits translation initiation by curtailing mammalian target of rapamycin signaling". *Cancer Res*. **70** (8): 3199–208\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1158/0008-5472.CAN-09-4072](https://doi.org/10.1158%2F0008-5472.CAN-09-4072). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20354178](https://pubmed.ncbi.nlm.nih.gov/20354178). `{{cite journal}}`: CS1 maint: multiple names: authors list ([link](https://en.wikipedia.org/wiki/Category:CS1_maint:_multiple_names:_authors_list "Category:CS1 maint: multiple names: authors list")) 145. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-145)** Hui-Yun Hwang, Joong Sup Shim, Dasol Kim, Ho Jeong Kwon (October 2021). ["Antidepressant drug sertraline modulates AMPK-MTOR signaling-mediated autophagy via targeting mitochondrial VDAC1 protein"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8525979). *Autophagy*. **17** (10): 2783–2799\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1080/15548627.2020.1841953](https://doi.org/10.1080%2F15548627.2020.1841953). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [8525979](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8525979). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [33124469](https://pubmed.ncbi.nlm.nih.gov/33124469). `{{cite journal}}`: CS1 maint: multiple names: authors list ([link](https://en.wikipedia.org/wiki/Category:CS1_maint:_multiple_names:_authors_list "Category:CS1 maint: multiple names: authors list")) 146. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-146)** Huan Zhang, Huanji Xu, Qiulin Tang, Feng Bi (1 September 2021). "The selective serotonin reuptake inhibitors enhance the cytotoxicity of sorafenib in hepatocellular carcinoma cells". *Anticancer Drugs*. **32** (8): 793–801\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1097/CAD.0000000000001067](https://doi.org/10.1097%2FCAD.0000000000001067). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [33675613](https://pubmed.ncbi.nlm.nih.gov/33675613). `{{cite journal}}`: CS1 maint: multiple names: authors list ([link](https://en.wikipedia.org/wiki/Category:CS1_maint:_multiple_names:_authors_list "Category:CS1 maint: multiple names: authors list")) 147. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-147)** Chaemi Lee, Seong Soon Kim, Myung Ae Bae, Seong Hwan Kim (25 April 2025). "Neuroprotective Activities of Sertraline, Tiagabine, and Bicifadine with Autophagy-Inducing Potentials in a 6-Hydroxidopamine-Treated Parkinson's Disease Cell Model". *Neurochem Res*. **50** (3): 154. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s11064-025-04404-z](https://doi.org/10.1007%2Fs11064-025-04404-z). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [40278973](https://pubmed.ncbi.nlm.nih.gov/40278973). `{{cite journal}}`: CS1 maint: multiple names: authors list ([link](https://en.wikipedia.org/wiki/Category:CS1_maint:_multiple_names:_authors_list "Category:CS1 maint: multiple names: authors list")) 148. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-In_Vivo_SERT_binding_148-0)** Sprouse J, Clarke T, Reynolds L, Heym J, Rollema H (April 1996). ["Comparison of the effects of sertraline and its metabolite desmethylsertraline on blockade of central 5-HT reuptake in vivo"](https://doi.org/10.1016%2F0893-133X%2895%2900112-Q). *Neuropsychopharmacology*. **14** (4): 225–231\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/0893-133X(95)00112-Q](https://doi.org/10.1016%2F0893-133X%2895%2900112-Q). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [8924190](https://pubmed.ncbi.nlm.nih.gov/8924190). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [39841365](https://api.semanticscholar.org/CorpusID:39841365). 149. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid10383917_149-0)** Kobayashi K, Ishizuka T, Shimada N, Yoshimura Y, Kamijima K, Chiba K (July 1999). "Sertraline N-demethylation is catalyzed by multiple isoforms of human cytochrome P-450 in vitro". *Drug Metabolism and Disposition*. **27** (7): 763–6\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0090-9556(24)15222-1](https://doi.org/10.1016%2FS0090-9556%2824%2915222-1). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [10383917](https://pubmed.ncbi.nlm.nih.gov/10383917). 150. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid29136336_150-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid29136336_150-1) [***c***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid29136336_150-2) Saiz-RodrĂ­guez M, Belmonte C, RomĂĄn M, Ochoa D, Koller D, TalegĂłn M, et al. (May 2018). ["Effect of Polymorphisms on the Pharmacokinetics, Pharmacodynamics and Safety of Sertraline in Healthy Volunteers"](https://doi.org/10.1111%2Fbcpt.12938). *Basic & Clinical Pharmacology & Toxicology*. **122** (5): 501–511\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1111/bcpt.12938](https://doi.org/10.1111%2Fbcpt.12938). [hdl](https://en.wikipedia.org/wiki/Hdl_\(identifier\) "Hdl (identifier)"):[10261/177557](https://hdl.handle.net/10261%2F177557). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [29136336](https://pubmed.ncbi.nlm.nih.gov/29136336). 151. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid31649299_151-0)** BrĂ„ten LS, Haslemo T, Jukic MM, Ingelman-Sundberg M, Molden E, Kringen MK (February 2020). ["Impact of CYP2C19 genotype on sertraline exposure in 1200 Scandinavian patients"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6969041). *Neuropsychopharmacology*. **45** (3): 570–576\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1038/s41386-019-0554-x](https://doi.org/10.1038%2Fs41386-019-0554-x). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6969041](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6969041). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [31649299](https://pubmed.ncbi.nlm.nih.gov/31649299). 152. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid33237321_152-0)** Milosavljevic F, Bukvic N, Pavlovic Z, Miljevic C, PeĆĄic V, Molden E, et al. (November 2020). ["Association of CYP2C19 and CYP2D6 Poor and Intermediate Metabolizer Status With Antidepressant and Antipsychotic Exposure: A Systematic Review and Meta-analysis"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7702196). *JAMA Psychiatry*. **78** (3): 270–280\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1001/jamapsychiatry.2020.3643](https://doi.org/10.1001%2Fjamapsychiatry.2020.3643). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [7702196](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7702196). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [33237321](https://pubmed.ncbi.nlm.nih.gov/33237321). 153. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Kachhadiya_2025_153-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Kachhadiya_2025_153-1) Kachhadiya RN, Shah BM (2025). ["Shaping the future of medicine through diverse therapeutic applications of tetralin derivatives"](https://www.researchgate.net/publication/385559544). *Medicinal Chemistry Research*. **34** (1): 86–113\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s00044-024-03331-y](https://doi.org/10.1007%2Fs00044-024-03331-y). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [1054-2523](https://search.worldcat.org/issn/1054-2523). 154. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Welch_154-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Welch_154-1) Welch WM (1995). *Discovery and Development of Sertraline*. Advances in Medicinal Chemistry. Vol. 3. pp. 113–148\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S1067-5698(06)80005-2](https://doi.org/10.1016%2FS1067-5698%2806%2980005-2). [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-1-55938-798-9](https://en.wikipedia.org/wiki/Special:BookSources/978-1-55938-798-9 "Special:BookSources/978-1-55938-798-9") . 155. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-155)** Sarges R, Tretter JR, Tenen SS, Weissman A (September 1973). "5,8-Disubstituted 1-aminotetralins. A class of compounds with a novel profile of central nervous system activity". *Journal of Medicinal Chemistry*. **16** (9): 1003–11\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1021/jm00267a010](https://doi.org/10.1021%2Fjm00267a010). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [4795663](https://pubmed.ncbi.nlm.nih.gov/4795663). 156. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-156)** Huddart R, Hicks JK, Ramsey LB, Strawn JR, Smith DM, Bobonis Babilonia M, et al. (February 2020). ["PharmGKB summary: sertraline pathway, pharmacokinetics"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008964). *Pharmacogenetics and Genomics*. **30** (2): 26–33\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1097/FPC.0000000000000392](https://doi.org/10.1097%2FFPC.0000000000000392). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [7008964](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008964). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [31851125](https://pubmed.ncbi.nlm.nih.gov/31851125). 157. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-157)** [U.S. patent 4,556,676](https://patents.google.com/patent/US4556676) 158. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-159)** See also: Mullin R (2006). ["ACS Award for Team Innovation"](https://doi.org/10.1021%2Fcen-v084n010.p045). *Chemical & Engineering News*. **84** (5): 45–52\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1021/cen-v084n010.p045](https://doi.org/10.1021%2Fcen-v084n010.p045). 159. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-160)** A short blurb on the history of sertraline, see: Couzin J (July 2005). "The brains behind blockbusters". *Science*. **309** (5735): 728. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1126/science.309.5735.728](https://doi.org/10.1126%2Fscience.309.5735.728). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [16051786](https://pubmed.ncbi.nlm.nih.gov/16051786). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [45532935](https://api.semanticscholar.org/CorpusID:45532935). 160. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-He168_161-0)** [Healy D](https://en.wikipedia.org/wiki/David_Healy_\(psychiatrist\) "David Healy (psychiatrist)") (1999). *The Antidepressant Era*. Cambridge, Massachusetts: Harvard University Press. p. 168. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-674-03958-2](https://en.wikipedia.org/wiki/Special:BookSources/978-0-674-03958-2 "Special:BookSources/978-0-674-03958-2") . 161. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pdac_162-0)** ["Minutes of the 33rd Meeting of Psychopharmacological Drugs Advisory Committee on November 19, 1990"](http://www.healyprozac.com/PDAC/PDAC-Zoloft%20Nov%2090.pdf) (PDF). FDA. 1990. Retrieved 11 July 2008. 162. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid8573661_163-0)** See also: Fabre LF, Abuzzahab FS, Amin M, Claghorn JL, Mendels J, Petrie WM, et al. (November 1995). "Sertraline safety and efficacy in major depression: a double-blind fixed-dose comparison with placebo". *Biological Psychiatry*. **38** (9): 592–602\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/0006-3223(95)00178-8](https://doi.org/10.1016%2F0006-3223%2895%2900178-8). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [8573661](https://pubmed.ncbi.nlm.nih.gov/8573661). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [27253073](https://api.semanticscholar.org/CorpusID:27253073). 163. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-164)** ["Safety review of antidepressants used by children completed"](https://web.archive.org/web/20080616231154/http://www.mhra.gov.uk/NewsCentre/Pressreleases/CON002045). [MHRA](https://en.wikipedia.org/wiki/Medicines_and_Healthcare_products_Regulatory_Agency "Medicines and Healthcare products Regulatory Agency"). 10 December 2003. Archived from [the original](http://www.mhra.gov.uk/NewsCentre/Pressreleases/CON002045) on 16 June 2008. Retrieved 11 July 2008. 164. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-165)** Boseley S (10 December 2003). ["Drugs for depressed children banned"](https://www.theguardian.com/uk_news/story/0,3604,1103563,00.html). *[The Guardian](https://en.wikipedia.org/wiki/The_Guardian "The Guardian")*. Retrieved 19 April 2007. 165. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-166)** ["Overview of regulatory status and CSM advice relating to major depressive disorder in children and adolescents"](https://web.archive.org/web/20080802183642/http://www.mhra.gov.uk/Safetyinformation/Safetywarningsalertsandrecalls/Safetywarningsandmessagesformedicines/CON019494). MHRA. Archived from [the original](http://www.mhra.gov.uk/Safetyinformation/Safetywarningsalertsandrecalls/Safetywarningsandmessagesformedicines/CON019494) on 2 August 2008. Retrieved 17 April 2008. 166. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-167)** Food and Drug Administration (2 May 2007). ["FDA Proposes New Warnings About Suicidal Thinking, Behavior in Young Adults Who Take Antidepressant Medications"](https://web.archive.org/web/20070505020340/http://www.fda.gov/bbs/topics/NEWS/2007/NEW01624.html). *[Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration")*. Archived from [the original](https://www.fda.gov/bbs/topics/NEWS/2007/NEW01624.html) on 5 May 2007. Retrieved 11 July 2008. 167. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-168)** Smith A (17 July 2006). ["Pfizer needs more drugs"](https://money.cnn.com/2006/07/17/news/companies/pfizer/index.htm). CNN. Retrieved 27 January 2007. 168. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-169)** ["Pfizer Completes Transaction to Combine Its Upjohn Business with Mylan"](https://www.businesswire.com/news/home/20201116005378/en/). Pfizer. 16 November 2020. Retrieved 17 June 2024 – via Business Wire. 169. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-170)** ["Zoloft"](https://www.pfizer.com/products/product-detail/zoloft). *Pfizer*. Retrieved 17 June 2024. 170. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-171)** ["Brands"](https://www.viatris.com/en/products/brands). *Viatris*. 16 November 2020. Retrieved 17 June 2024. 171. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid37731683_172-0)** Erdoğan Kaya A, Oğur NB (September 2023). ["The Impact of the COVID-19 Pandemic on the Interest in Antidepressants: An Analysis of Worldwide Internet Searches With Google Trends Data"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10508353). *Cureus*. **15** (9) e45558. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.7759/cureus.45558](https://doi.org/10.7759%2Fcureus.45558). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [10508353](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10508353). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [37731683](https://pubmed.ncbi.nlm.nih.gov/37731683). 172. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Ebola-treatment_173-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Ebola-treatment_173-1) - ‱ Cardile AP, Warren TK, Martins KA, Reisler RB, Bavari S (January 2017). ["Will There Be a Cure for Ebola?"](https://doi.org/10.1146%2Fannurev-pharmtox-010716-105055). *Annual Review of Pharmacology and Toxicology*. **57** (1). [Annual Reviews](https://en.wikipedia.org/wiki/Annual_Reviews_\(publisher\) "Annual Reviews (publisher)"): 329–348\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1146/annurev-pharmtox-010716-105055](https://doi.org/10.1146%2Fannurev-pharmtox-010716-105055). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27959624](https://pubmed.ncbi.nlm.nih.gov/27959624). - ‱ Johansen LM, DeWald LE, Shoemaker CJ, Hoffstrom BG, Lear-Rooney CM, Stossel A, et al. (June 2015). ["A screen of approved drugs and molecular probes identifies therapeutics with anti-Ebola virus activity"](https://doi.org/10.1126%2Fscitranslmed.aaa5597). *[Science Translational Medicine](https://en.wikipedia.org/wiki/Science_Translational_Medicine "Science Translational Medicine")*. **7** (290). [American Association for the Advancement of Science](https://en.wikipedia.org/wiki/American_Association_for_the_Advancement_of_Science "American Association for the Advancement of Science") (AAAS): 290ra89. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1126/scitranslmed.aaa5597](https://doi.org/10.1126%2Fscitranslmed.aaa5597). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26041706](https://pubmed.ncbi.nlm.nih.gov/26041706). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [88805622](https://api.semanticscholar.org/CorpusID:88805622). 173. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Phospholipase-B_174-0)** - ‱ Lass-Flörl C, Ledochowski M, Fuchs D, Speth C, Kacani L, Dierich MP, et al. (January 2003). ["Interaction of sertraline with Candida species selectively attenuates fungal virulence in vitro"](https://doi.org/10.1111%2Fj.1574-695x.2003.tb00643.x). *FEMS Immunology and Medical Microbiology*. **35** (1). [Oxford University Press](https://en.wikipedia.org/wiki/Oxford_University_Press "Oxford University Press") ([Federation of European Microbiological Societies](https://en.wikipedia.org/wiki/Federation_of_European_Microbiological_Societies "Federation of European Microbiological Societies")): 11–15\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1111/j.1574-695x.2003.tb00643.x](https://doi.org/10.1111%2Fj.1574-695x.2003.tb00643.x). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [12589952](https://pubmed.ncbi.nlm.nih.gov/12589952). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [11240443](https://api.semanticscholar.org/CorpusID:11240443). - ‱ Schaller M, Borelli C, Korting HC, Hube B (November 2005). "Hydrolytic enzymes as virulence factors of *Candida albicans*". *[Mycoses](https://en.wikipedia.org/wiki/Mycoses_\(journal\) "Mycoses (journal)")*. **48** (6). [Blackwell Publishing](https://en.wikipedia.org/wiki/Blackwell_Publishing "Blackwell Publishing"): 365–377\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1111/j.1439-0507.2005.01165.x](https://doi.org/10.1111%2Fj.1439-0507.2005.01165.x). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [16262871](https://pubmed.ncbi.nlm.nih.gov/16262871). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [1356254](https://api.semanticscholar.org/CorpusID:1356254). - ‱ Lyte M, ed. (2016). *Microbial Endocrinology: Interkingdom Signaling in Infectious Disease and Health*. Advances in Experimental Medicine and Biology. Vol. 874. [Cham, Switzerland](https://en.wikipedia.org/wiki/Cham,_Switzerland "Cham, Switzerland"): Springer. pp. xiii+374. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/978-3-319-20215-0](https://doi.org/10.1007%2F978-3-319-20215-0). [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-3-319-20215-0](https://en.wikipedia.org/wiki/Special:BookSources/978-3-319-20215-0 "Special:BookSources/978-3-319-20215-0") . [OCLC](https://en.wikipedia.org/wiki/OCLC_\(identifier\) "OCLC (identifier)") [932167823](https://search.worldcat.org/oclc/932167823). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [7784624](https://api.semanticscholar.org/CorpusID:7784624). [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-3-319-20214-3](https://en.wikipedia.org/wiki/Special:BookSources/978-3-319-20214-3 "Special:BookSources/978-3-319-20214-3") . [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-3-319-79299-6](https://en.wikipedia.org/wiki/Special:BookSources/978-3-319-79299-6 "Special:BookSources/978-3-319-79299-6") . : 349, 355 - ‱ Cussotto S, Clarke G, Dinan TG, Cryan JF (May 2019). ["Psychotropics and the Microbiome: a Chamber of Secrets..."](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598948) *Psychopharmacology*. **236** (5). [Springer Science and Business Media](https://en.wikipedia.org/wiki/Springer_Science_and_Business_Media "Springer Science and Business Media") ([European Behavioural Pharmacology Society](https://en.wikipedia.org/w/index.php?title=European_Behavioural_Pharmacology_Society&action=edit&redlink=1 "European Behavioural Pharmacology Society (page does not exist)") (EBPS)): 1411–1432\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s00213-019-5185-8](https://doi.org/10.1007%2Fs00213-019-5185-8). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6598948](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598948). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [30806744](https://pubmed.ncbi.nlm.nih.gov/30806744). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [71145305](https://api.semanticscholar.org/CorpusID:71145305). 174. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Chamber-of-Secrets_175-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Chamber-of-Secrets_175-1) [***c***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Chamber-of-Secrets_175-2) Cussotto S, Clarke G, Dinan TG, Cryan JF (May 2019). ["Psychotropics and the Microbiome: a Chamber of Secrets..."](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598948) *Psychopharmacology*. **236** (5). [Springer Science and Business Media](https://en.wikipedia.org/wiki/Springer_Science_and_Business_Media "Springer Science and Business Media") ([European Behavioural Pharmacology Society](https://en.wikipedia.org/w/index.php?title=European_Behavioural_Pharmacology_Society&action=edit&redlink=1 "European Behavioural Pharmacology Society (page does not exist)") (EBPS)): 1411–1432\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s00213-019-5185-8](https://doi.org/10.1007%2Fs00213-019-5185-8). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6598948](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598948). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [30806744](https://pubmed.ncbi.nlm.nih.gov/30806744). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [71145305](https://api.semanticscholar.org/CorpusID:71145305). 175. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Photosensitizers_176-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Photosensitizers_176-1) [***c***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Photosensitizers_176-2) Maldonado-Carmona N, Ouk TS, Calvete MJ, Pereira MM, Villandier N, Leroy-Lhez S (April 2020). ["Conjugating biomaterials with photosensitizers: advances and perspectives for photodynamic antimicrobial chemotherapy"](https://doi.org/10.1039%2FC9PP00398C). Paper. *Photochemical & Photobiological Sciences*. **19** (4). [Royal Society of Chemistry](https://en.wikipedia.org/wiki/Royal_Society_of_Chemistry "Royal Society of Chemistry") (RSC): 445–461\. [Bibcode](https://en.wikipedia.org/wiki/Bibcode_\(identifier\) "Bibcode (identifier)"):[2020PhPhS..19..445M](https://ui.adsabs.harvard.edu/abs/2020PhPhS..19..445M). [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1039/C9PP00398C](https://doi.org/10.1039%2FC9PP00398C). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [32104827](https://pubmed.ncbi.nlm.nih.gov/32104827). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [211537822](https://api.semanticscholar.org/CorpusID:211537822). 176. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Immunomodulation_177-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Immunomodulation_177-1) Arreola R, Becerril-Villanueva E, Cruz-Fuentes C, Velasco-VelĂĄzquez MA, GarcĂ©s-Alvarez ME, Hurtado-Alvarado G, et al. (2015). ["Immunomodulatory effects mediated by serotonin"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4417587). *Journal of Immunology Research*. **2015** 354957. [Hindawi Publishing Corporation](https://en.wikipedia.org/wiki/Hindawi_Publishing_Corporation "Hindawi Publishing Corporation"). [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1155/2015/354957](https://doi.org/10.1155%2F2015%2F354957). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4417587](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4417587). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25961058](https://pubmed.ncbi.nlm.nih.gov/25961058). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [17202427](https://api.semanticscholar.org/CorpusID:17202427). 354957. 177. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-tcruz_178-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-tcruz_178-1) [***c***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-tcruz_178-2) Hassanzadeh P, Atyabi F, Dinarvand R (2019). "The significance of artificial intelligence in drug delivery system design". *Advanced Drug Delivery Reviews*. 151–152\. [Elsevier BV](https://en.wikipedia.org/wiki/Elsevier_BV "Elsevier BV"): 169–190\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.addr.2019.05.001](https://doi.org/10.1016%2Fj.addr.2019.05.001). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [31071378](https://pubmed.ncbi.nlm.nih.gov/31071378). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [149445737](https://api.semanticscholar.org/CorpusID:149445737). This review cites this study: Ferreira DD, Mesquita JT, da Costa Silva TA, Romanelli MM, da Gama Jaen Batista D, da Silva CF, et al. (2018). ["Efficacy of sertraline against *Trypanosoma cruzi*: an in vitro and in silico study"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208092). *The Journal of Venomous Animals and Toxins Including Tropical Diseases*. **24** (1) 30. [Springer Science and Business Media LLC](https://en.wikipedia.org/wiki/Springer_Science_and_Business_Media_LLC "Springer Science and Business Media LLC"). [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1186/s40409-018-0165-8](https://doi.org/10.1186%2Fs40409-018-0165-8). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6208092](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208092). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [30450114](https://pubmed.ncbi.nlm.nih.gov/30450114). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [53114045](https://api.semanticscholar.org/CorpusID:53114045). CEVAP/UNESP - [Centro de Estudos de Venenos e Animais Peçonhentos](https://en.wikipedia.org/w/index.php?title=Centro_de_Estudos_de_Venenos_e_Animais_Pe%C3%A7onhentos&action=edit&redlink=1 "Centro de Estudos de Venenos e Animais Peçonhentos (page does not exist)") SĂŁo Paulo State University. 178. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-179)** "Sertraline". [*Drugs and Lactation Database (LactMed)*](http://www.ncbi.nlm.nih.gov/books/NBK501191/). Bethesda (MD): National Institute of Child Health and Human Development. May 2025. [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [30000250](https://pubmed.ncbi.nlm.nih.gov/30000250). Bookshelf ID: NBK501191. Retrieved 31 August 2025. ## External links \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=35 "Edit section: External links")\] [![Wikimedia Commons logo](https://upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/40px-Commons-logo.svg.png)](https://en.wikipedia.org/wiki/File:Commons-logo.svg) Wikimedia Commons has media related to [Sertraline](https://commons.wikimedia.org/wiki/Category:Sertraline "commons:Category:Sertraline"). | [v](https://en.wikipedia.org/wiki/Template:Antidepressants "Template:Antidepressants") [t](https://en.wikipedia.org/wiki/Template_talk:Antidepressants "Template talk:Antidepressants") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Antidepressants "Special:EditPage/Template:Antidepressants")[Antidepressants](https://en.wikipedia.org/wiki/Antidepressant "Antidepressant") ([N06A](https://en.wikipedia.org/wiki/ATC_code_N06#N06A "ATC code N06")) | | |---|---| | Specific [reuptake inhibitors](https://en.wikipedia.org/wiki/Reuptake_inhibitor "Reuptake inhibitor") or [receptor modulators](https://en.wikipedia.org/wiki/Receptor_modulator "Receptor modulator") | | | | | | [SSRIs](https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitors "Selective serotonin reuptake inhibitors")Tooltip Selective serotonin reuptake inhibitors | [Citalopram](https://en.wikipedia.org/wiki/Citalopram "Citalopram")\# [Escitalopram](https://en.wikipedia.org/wiki/Escitalopram "Escitalopram")\# [Fluoxetine](https://en.wikipedia.org/wiki/Fluoxetine "Fluoxetine")\# [Fluvoxamine](https://en.wikipedia.org/wiki/Fluvoxamine "Fluvoxamine")\# [Indalpine](https://en.wikipedia.org/wiki/Indalpine "Indalpine")‡ [Paroxetine](https://en.wikipedia.org/wiki/Paroxetine "Paroxetine")\# [Sertraline]()\# [Zimelidine](https://en.wikipedia.org/wiki/Zimelidine "Zimelidine")‡ | | [SNRIs](https://en.wikipedia.org/wiki/Serotonin%E2%80%93norepinephrine_reuptake_inhibitors "Serotonin–norepinephrine reuptake inhibitors")Tooltip Serotonin–norepinephrine reuptake inhibitors | [Desvenlafaxine](https://en.wikipedia.org/wiki/Desvenlafaxine "Desvenlafaxine") [Duloxetine](https://en.wikipedia.org/wiki/Duloxetine "Duloxetine") [Levomilnacipran](https://en.wikipedia.org/wiki/Levomilnacipran "Levomilnacipran") [Milnacipran](https://en.wikipedia.org/wiki/Milnacipran "Milnacipran") [Tofenacin](https://en.wikipedia.org/wiki/Tofenacin "Tofenacin") [Venlafaxine](https://en.wikipedia.org/wiki/Venlafaxine "Venlafaxine") | | [NRIs](https://en.wikipedia.org/wiki/Norepinephrine_reuptake_inhibitors "Norepinephrine reuptake inhibitors")Tooltip Norepinephrine reuptake inhibitors | [Atomoxetine](https://en.wikipedia.org/wiki/Atomoxetine "Atomoxetine") [Reboxetine](https://en.wikipedia.org/wiki/Reboxetine "Reboxetine") [Viloxazine](https://en.wikipedia.org/wiki/Viloxazine "Viloxazine") | | [NDRIs](https://en.wikipedia.org/wiki/Norepinephrine%E2%80%93dopamine_reuptake_inhibitors "Norepinephrine–dopamine reuptake inhibitors")Tooltip Norepinephrine–dopamine reuptake inhibitors | [Amineptine](https://en.wikipedia.org/wiki/Amineptine "Amineptine")‡ [Bupropion](https://en.wikipedia.org/wiki/Bupropion "Bupropion") [Nomifensine](https://en.wikipedia.org/wiki/Nomifensine "Nomifensine")‡ | | [NaSSAs](https://en.wikipedia.org/wiki/Noradrenergic_and_specific_serotonergic_antidepressants "Noradrenergic and specific serotonergic antidepressants")Tooltip Noradrenergic and specific serotonergic antidepressants | [Mianserin](https://en.wikipedia.org/wiki/Mianserin "Mianserin") [Mirtazapine](https://en.wikipedia.org/wiki/Mirtazapine "Mirtazapine") [Setiptiline](https://en.wikipedia.org/wiki/Setiptiline "Setiptiline") | | [SARIs](https://en.wikipedia.org/wiki/Serotonin_antagonist_and_reuptake_inhibitors "Serotonin antagonist and reuptake inhibitors")Tooltip Serotonin antagonist and reuptake inhibitors | [Etoperidone](https://en.wikipedia.org/wiki/Etoperidone "Etoperidone") [Nefazodone](https://en.wikipedia.org/wiki/Nefazodone "Nefazodone") [Trazodone](https://en.wikipedia.org/wiki/Trazodone "Trazodone") | | [SMS](https://en.wikipedia.org/wiki/Serotonin_modulator_and_stimulators "Serotonin modulator and stimulators")Tooltip Serotonin modulator and stimulators | [Vilazodone](https://en.wikipedia.org/wiki/Vilazodone "Vilazodone") [Vortioxetine](https://en.wikipedia.org/wiki/Vortioxetine "Vortioxetine") | | Others | [Agomelatine](https://en.wikipedia.org/wiki/Agomelatine "Agomelatine") [Amisulpride](https://en.wikipedia.org/wiki/Amisulpride "Amisulpride") [Dextromethorphan/bupropion](https://en.wikipedia.org/wiki/Dextromethorphan/bupropion "Dextromethorphan/bupropion") [Esketamine](https://en.wikipedia.org/wiki/Esketamine "Esketamine") [Etryptamine](https://en.wikipedia.org/wiki/Alpha-Ethyltryptamine "Alpha-Ethyltryptamine")‡ [Gepirone](https://en.wikipedia.org/wiki/Gepirone "Gepirone") [Indeloxazine](https://en.wikipedia.org/wiki/Indeloxazine "Indeloxazine") [Flupentixol](https://en.wikipedia.org/wiki/Flupentixol "Flupentixol") [Ketamine](https://en.wikipedia.org/wiki/Ketamine "Ketamine")§ [Medifoxamine](https://en.wikipedia.org/wiki/Medifoxamine "Medifoxamine")‡ [Metryptamine](https://en.wikipedia.org/wiki/Alpha-Methyltryptamine "Alpha-Methyltryptamine")‡ [Oxaflozane](https://en.wikipedia.org/wiki/Oxaflozane "Oxaflozane")‡ [Pivagabine](https://en.wikipedia.org/wiki/Pivagabine "Pivagabine")‡ [Tandospirone](https://en.wikipedia.org/wiki/Tandospirone "Tandospirone") [Teniloxazine](https://en.wikipedia.org/wiki/Teniloxazine "Teniloxazine") [Tianeptine](https://en.wikipedia.org/wiki/Tianeptine "Tianeptine") | | [Tricyclic](https://en.wikipedia.org/wiki/Tricyclic "Tricyclic") and [tetracyclic antidepressants](https://en.wikipedia.org/wiki/Tetracyclic_antidepressant "Tetracyclic antidepressant") | | | | | | [TCAs](https://en.wikipedia.org/wiki/Tricyclic_antidepressants "Tricyclic antidepressants")Tooltip Tricyclic antidepressants | [Amineptine](https://en.wikipedia.org/wiki/Amineptine "Amineptine")‡ [Amitriptyline](https://en.wikipedia.org/wiki/Amitriptyline "Amitriptyline")\# [Amitriptylinoxide](https://en.wikipedia.org/wiki/Amitriptylinoxide "Amitriptylinoxide") [Amoxapine](https://en.wikipedia.org/wiki/Amoxapine "Amoxapine") [Butriptyline](https://en.wikipedia.org/wiki/Butriptyline "Butriptyline")‡ [Clomipramine](https://en.wikipedia.org/wiki/Clomipramine "Clomipramine")\# [Demexiptiline](https://en.wikipedia.org/wiki/Demexiptiline "Demexiptiline")‡ [Desipramine](https://en.wikipedia.org/wiki/Desipramine "Desipramine") [Dibenzepin](https://en.wikipedia.org/wiki/Dibenzepin "Dibenzepin") [Dimetacrine](https://en.wikipedia.org/wiki/Dimetacrine "Dimetacrine")‡ [Dosulepin](https://en.wikipedia.org/wiki/Dosulepin "Dosulepin") [Doxepin](https://en.wikipedia.org/wiki/Doxepin "Doxepin") [Imipramine](https://en.wikipedia.org/wiki/Imipramine "Imipramine") [Imipraminoxide](https://en.wikipedia.org/wiki/Imipraminoxide "Imipraminoxide")‡ [Iprindole](https://en.wikipedia.org/wiki/Iprindole "Iprindole")‡ [Lofepramine](https://en.wikipedia.org/wiki/Lofepramine "Lofepramine") [Melitracen](https://en.wikipedia.org/wiki/Melitracen "Melitracen") [Metapramine](https://en.wikipedia.org/wiki/Metapramine "Metapramine")‡ [Nitroxazepine](https://en.wikipedia.org/wiki/Nitroxazepine "Nitroxazepine") [Nortriptyline](https://en.wikipedia.org/wiki/Nortriptyline "Nortriptyline") [Noxiptiline](https://en.wikipedia.org/wiki/Noxiptiline "Noxiptiline") [Opipramol](https://en.wikipedia.org/wiki/Opipramol "Opipramol") [Pipofezine](https://en.wikipedia.org/wiki/Pipofezine "Pipofezine") [Propizepine](https://en.wikipedia.org/wiki/Propizepine "Propizepine")‡ [Protriptyline](https://en.wikipedia.org/wiki/Protriptyline "Protriptyline") [Quinupramine](https://en.wikipedia.org/wiki/Quinupramine "Quinupramine")‡ [Tianeptine](https://en.wikipedia.org/wiki/Tianeptine "Tianeptine") [Trimipramine](https://en.wikipedia.org/wiki/Trimipramine "Trimipramine") | | [TeCAs](https://en.wikipedia.org/wiki/Tetracyclic_antidepressants "Tetracyclic antidepressants")Tooltip Tetracyclic antidepressants | [Maprotiline](https://en.wikipedia.org/wiki/Maprotiline "Maprotiline") [Mianserin](https://en.wikipedia.org/wiki/Mianserin "Mianserin") [Mirtazapine](https://en.wikipedia.org/wiki/Mirtazapine "Mirtazapine") [Setiptiline](https://en.wikipedia.org/wiki/Setiptiline "Setiptiline") | | Others | [Tiazesim](https://en.wikipedia.org/wiki/Tiazesim "Tiazesim") | | [Monoamine oxidase inhibitors](https://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor "Monoamine oxidase inhibitor") | | | | | | Non-selective | *Irreversible:* [Benmoxin](https://en.wikipedia.org/wiki/Benmoxin "Benmoxin")‡ [Iproclozide](https://en.wikipedia.org/wiki/Iproclozide "Iproclozide")‡ [Iproniazid](https://en.wikipedia.org/wiki/Iproniazid "Iproniazid")‡ [Isocarboxazid](https://en.wikipedia.org/wiki/Isocarboxazid "Isocarboxazid") [Isoniazid](https://en.wikipedia.org/wiki/Isoniazid "Isoniazid")\# [Linezolid](https://en.wikipedia.org/wiki/Linezolid "Linezolid")\# [Mebanazine](https://en.wikipedia.org/wiki/Mebanazine "Mebanazine")‡ [Nialamide](https://en.wikipedia.org/wiki/Nialamide "Nialamide")‡ [Octamoxin](https://en.wikipedia.org/wiki/Octamoxin "Octamoxin")‡ [Phenelzine](https://en.wikipedia.org/wiki/Phenelzine "Phenelzine") [Pheniprazine](https://en.wikipedia.org/wiki/Pheniprazine "Pheniprazine")‡ [Phenoxypropazine](https://en.wikipedia.org/wiki/Phenoxypropazine "Phenoxypropazine")‡ [Pivhydrazine](https://en.wikipedia.org/wiki/Pivhydrazine "Pivhydrazine")‡ [Safrazine](https://en.wikipedia.org/wiki/Safrazine "Safrazine")‡ [Tedizolid](https://en.wikipedia.org/wiki/Tedizolid "Tedizolid") [Tranylcypromine](https://en.wikipedia.org/wiki/Tranylcypromine "Tranylcypromine") *Reversible:* [Caroxazone](https://en.wikipedia.org/wiki/Caroxazone "Caroxazone")‡ *Mixed:* [Bifemelane](https://en.wikipedia.org/wiki/Bifemelane "Bifemelane") | | [MAOA](https://en.wikipedia.org/wiki/Monoamine_oxidase_A "Monoamine oxidase A")Tooltip Monoamine oxidase A\-selective | *Reversible:* [Eprobemide](https://en.wikipedia.org/wiki/Eprobemide "Eprobemide") [Metralindole](https://en.wikipedia.org/wiki/Metralindole "Metralindole") [Minaprine](https://en.wikipedia.org/wiki/Minaprine "Minaprine")‡ [Moclobemide](https://en.wikipedia.org/wiki/Moclobemide "Moclobemide") [Pirlindole](https://en.wikipedia.org/wiki/Pirlindole "Pirlindole") [Tetrindole](https://en.wikipedia.org/wiki/Tetrindole "Tetrindole") [Toloxatone](https://en.wikipedia.org/wiki/Toloxatone "Toloxatone") | | [MAOB](https://en.wikipedia.org/wiki/Monoamine_oxidase_B "Monoamine oxidase B")Tooltip Monoamine oxidase B\-selective | *Irreversible:* [Selegiline](https://en.wikipedia.org/wiki/Selegiline "Selegiline") | | [Adjunctive therapies](https://en.wikipedia.org/wiki/Adjuvant_therapy "Adjuvant therapy") | | | [Atypical antipsychotics](https://en.wikipedia.org/wiki/Atypical_antipsychotic "Atypical antipsychotic") ([aripiprazole](https://en.wikipedia.org/wiki/Aripiprazole "Aripiprazole"), [brexpiprazole](https://en.wikipedia.org/wiki/Brexpiprazole "Brexpiprazole"), [lurasidone](https://en.wikipedia.org/wiki/Lurasidone "Lurasidone"), [olanzapine](https://en.wikipedia.org/wiki/Olanzapine "Olanzapine"), [quetiapine](https://en.wikipedia.org/wiki/Quetiapine "Quetiapine"), [risperidone](https://en.wikipedia.org/wiki/Risperidone "Risperidone")) [Buspirone](https://en.wikipedia.org/wiki/Buspirone "Buspirone") [Lithium](https://en.wikipedia.org/wiki/Lithium_\(medication\) "Lithium (medication)") ([lithium carbonate](https://en.wikipedia.org/wiki/Lithium_carbonate "Lithium carbonate"), [lithium citrate](https://en.wikipedia.org/wiki/Lithium_citrate "Lithium citrate")) [Thyroid hormones](https://en.wikipedia.org/wiki/Thyroid_hormone "Thyroid hormone") ([triiodothyronine](https://en.wikipedia.org/wiki/Triiodothyronine "Triiodothyronine") (T3), [levothyroxine](https://en.wikipedia.org/wiki/Levothyroxine "Levothyroxine") (T4)) | | | Miscellaneous | | | [Ademetionine (SAMe)](https://en.wikipedia.org/wiki/Ademetionine "Ademetionine") [GABAkine](https://en.wikipedia.org/wiki/GABAA_receptor_positive_allosteric_modulator "GABAA receptor positive allosteric modulator") [neurosteroids](https://en.wikipedia.org/wiki/Neurosteroid "Neurosteroid") ([brexanolone](https://en.wikipedia.org/wiki/Allopregnanolone "Allopregnanolone"), [zuranolone](https://en.wikipedia.org/wiki/Zuranolone "Zuranolone")) [*Hypericum perforatum* (St. John's Wort)](https://en.wikipedia.org/wiki/Hypericum_perforatum "Hypericum perforatum") [Oxitriptan (5-HTP)](https://en.wikipedia.org/wiki/Oxitriptan "Oxitriptan") [Rubidium chloride (RbCl)](https://en.wikipedia.org/wiki/Rubidium_chloride "Rubidium chloride") [Tryptophan](https://en.wikipedia.org/wiki/Tryptophan "Tryptophan") | | | \#[WHO-EM](https://en.wikipedia.org/wiki/WHO_Model_List_of_Essential_Medicines "WHO Model List of Essential Medicines") ‡[Withdrawn](https://en.wikipedia.org/wiki/List_of_withdrawn_drugs "List of withdrawn drugs") from market [Clinical trials](https://en.wikipedia.org/wiki/Clinical_trial "Clinical trial"): †[Phase III](https://en.wikipedia.org/wiki/Phases_of_clinical_research#Phase_III "Phases of clinical research") §Never to phase III | | | [v](https://en.wikipedia.org/wiki/Template:Anxiolytics "Template:Anxiolytics") [t](https://en.wikipedia.org/wiki/Template_talk:Anxiolytics "Template talk:Anxiolytics") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Anxiolytics "Special:EditPage/Template:Anxiolytics")[Anxiolytics](https://en.wikipedia.org/wiki/Anxiolytic "Anxiolytic") ([N05B](https://en.wikipedia.org/wiki/ATC_code_N05#N05B "ATC code N05")) | | |---|---| | [5-HT1AR](https://en.wikipedia.org/wiki/5-HT1A_receptor "5-HT1A receptor")Tooltip 5-HT1A receptor [agonists](https://en.wikipedia.org/wiki/Agonist "Agonist") | [Buspirone](https://en.wikipedia.org/wiki/Buspirone "Buspirone") [Gepirone](https://en.wikipedia.org/wiki/Gepirone "Gepirone") [Tandospirone](https://en.wikipedia.org/wiki/Tandospirone "Tandospirone") | | [GABAAR](https://en.wikipedia.org/wiki/GABAA_receptor "GABAA receptor")Tooltip GABAA receptor [PAMs](https://en.wikipedia.org/wiki/Positive_allosteric_modulators "Positive allosteric modulators")Tooltip positive allosteric modulators | *[Benzodiazepines](https://en.wikipedia.org/wiki/Benzodiazepine "Benzodiazepine"):* [Adinazolam](https://en.wikipedia.org/wiki/Adinazolam "Adinazolam") [Alprazolam](https://en.wikipedia.org/wiki/Alprazolam "Alprazolam") [Bromazepam](https://en.wikipedia.org/wiki/Bromazepam "Bromazepam") [Camazepam](https://en.wikipedia.org/wiki/Camazepam "Camazepam") [Chlordiazepoxide](https://en.wikipedia.org/wiki/Chlordiazepoxide "Chlordiazepoxide") [Clobazam](https://en.wikipedia.org/wiki/Clobazam "Clobazam") [Clonazepam](https://en.wikipedia.org/wiki/Clonazepam "Clonazepam") [Clorazepate](https://en.wikipedia.org/wiki/Clorazepate "Clorazepate") [Clotiazepam](https://en.wikipedia.org/wiki/Clotiazepam "Clotiazepam") [Cloxazolam](https://en.wikipedia.org/wiki/Cloxazolam "Cloxazolam") [Diazepam](https://en.wikipedia.org/wiki/Diazepam "Diazepam")\# [Ethyl loflazepate](https://en.wikipedia.org/wiki/Ethyl_loflazepate "Ethyl loflazepate") [Etizolam](https://en.wikipedia.org/wiki/Etizolam "Etizolam") [Fludiazepam](https://en.wikipedia.org/wiki/Fludiazepam "Fludiazepam") [Halazepam](https://en.wikipedia.org/wiki/Halazepam "Halazepam") [Ketazolam](https://en.wikipedia.org/wiki/Ketazolam "Ketazolam") [Lorazepam](https://en.wikipedia.org/wiki/Lorazepam "Lorazepam")\# [Medazepam](https://en.wikipedia.org/wiki/Medazepam "Medazepam") [Nordazepam](https://en.wikipedia.org/wiki/Nordazepam "Nordazepam") [Oxazepam](https://en.wikipedia.org/wiki/Oxazepam "Oxazepam") [Pinazepam](https://en.wikipedia.org/wiki/Pinazepam "Pinazepam") [Prazepam](https://en.wikipedia.org/wiki/Prazepam "Prazepam"); *Others:* [Alpidem](https://en.wikipedia.org/wiki/Alpidem "Alpidem")‡ [Barbiturates](https://en.wikipedia.org/wiki/Barbiturate "Barbiturate") (e.g., [phenobarbital](https://en.wikipedia.org/wiki/Phenobarbital "Phenobarbital")) [Carbamates](https://en.wikipedia.org/wiki/Carbamate "Carbamate") (e.g., [meprobamate](https://en.wikipedia.org/wiki/Meprobamate "Meprobamate")) [Carisoprodol](https://en.wikipedia.org/wiki/Carisoprodol "Carisoprodol") [Chlormezanone](https://en.wikipedia.org/wiki/Chlormezanone "Chlormezanone")‡ [Ethanol (alcohol)](https://en.wikipedia.org/wiki/Alcohol_\(drug\) "Alcohol (drug)") [Etifoxine](https://en.wikipedia.org/wiki/Etifoxine "Etifoxine") | | [Gabapentinoids](https://en.wikipedia.org/wiki/Gabapentinoid "Gabapentinoid") ( [α2ÎŽ VDCC](https://en.wikipedia.org/wiki/Voltage-dependent_calcium_channel#.CE.B12.CE.B4_Subunit "Voltage-dependent calcium channel") [blockers](https://en.wikipedia.org/wiki/Channel_blocker "Channel blocker")) | [Gabapentin](https://en.wikipedia.org/wiki/Gabapentin "Gabapentin") [Gabapentin enacarbil](https://en.wikipedia.org/wiki/Gabapentin_enacarbil "Gabapentin enacarbil") [Phenibut](https://en.wikipedia.org/wiki/Phenibut "Phenibut") [Baclofen](https://en.wikipedia.org/wiki/Baclofen "Baclofen") [Pregabalin](https://en.wikipedia.org/wiki/Pregabalin "Pregabalin") | | [Antidepressants](https://en.wikipedia.org/wiki/Antidepressant "Antidepressant") | [SSRIs](https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitors "Selective serotonin reuptake inhibitors") Tooltip Selective serotonin reuptake inhibitors (e.g., [escitalopram](https://en.wikipedia.org/wiki/Escitalopram "Escitalopram")) [SNRIs](https://en.wikipedia.org/wiki/Serotonin-norepinephrine_reuptake_inhibitors "Serotonin-norepinephrine reuptake inhibitors") Tooltip Serotonin-norepinephrine reuptake inhibitors (e.g., [duloxetine](https://en.wikipedia.org/wiki/Duloxetine "Duloxetine")) [SARIs](https://en.wikipedia.org/wiki/Serotonin_antagonist_and_reuptake_inhibitors "Serotonin antagonist and reuptake inhibitors") Tooltip Serotonin antagonist and reuptake inhibitors (e.g., [trazodone](https://en.wikipedia.org/wiki/Trazodone "Trazodone")) [TCAs](https://en.wikipedia.org/wiki/Tricyclic_antidepressants "Tricyclic antidepressants") Tooltip Tricyclic antidepressants (e.g., [clomipramine](https://en.wikipedia.org/wiki/Clomipramine "Clomipramine")\#) [TeCAs](https://en.wikipedia.org/wiki/Tetracyclic_antidepressants "Tetracyclic antidepressants") Tooltip Tetracyclic antidepressants (e.g., [mirtazapine](https://en.wikipedia.org/wiki/Mirtazapine "Mirtazapine")) [MAOIs](https://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitors "Monoamine oxidase inhibitors") Tooltip Monoamine oxidase inhibitors (e.g., [phenelzine](https://en.wikipedia.org/wiki/Phenelzine "Phenelzine")); *Others:* [Agomelatine](https://en.wikipedia.org/wiki/Agomelatine "Agomelatine") [Bupropion](https://en.wikipedia.org/wiki/Bupropion "Bupropion") [Tianeptine](https://en.wikipedia.org/wiki/Tianeptine "Tianeptine") [Vilazodone](https://en.wikipedia.org/wiki/Vilazodone "Vilazodone") [Vortioxetine](https://en.wikipedia.org/wiki/Vortioxetine "Vortioxetine") | | [Sympatholytics](https://en.wikipedia.org/wiki/Sympatholytic "Sympatholytic") ([Antiadrenergics](https://en.wikipedia.org/wiki/Antiadrenergic "Antiadrenergic")) | [Alpha-1 blockers](https://en.wikipedia.org/wiki/Alpha-1_blocker "Alpha-1 blocker") (e.g., [prazosin](https://en.wikipedia.org/wiki/Prazosin "Prazosin")) [Alpha-2 agonists](https://en.wikipedia.org/wiki/Alpha-2_agonist "Alpha-2 agonist") (e.g., [clonidine](https://en.wikipedia.org/wiki/Clonidine "Clonidine"), [dexmedetomidine](https://en.wikipedia.org/wiki/Dexmedetomidine "Dexmedetomidine"), [guanfacine](https://en.wikipedia.org/wiki/Guanfacine "Guanfacine")) [Beta blockers](https://en.wikipedia.org/wiki/Beta_blocker "Beta blocker") (e.g., [propranolol](https://en.wikipedia.org/wiki/Propranolol "Propranolol"), [atenolol](https://en.wikipedia.org/wiki/Atenolol "Atenolol"), [betaxolol](https://en.wikipedia.org/wiki/Betaxolol "Betaxolol"), [nadolol](https://en.wikipedia.org/wiki/Nadolol "Nadolol"), [oxprenolol](https://en.wikipedia.org/wiki/Oxprenolol "Oxprenolol"), [pindolol](https://en.wikipedia.org/wiki/Pindolol "Pindolol")) | | Others | [Benzoctamine](https://en.wikipedia.org/wiki/Benzoctamine "Benzoctamine") [Cycloserine](https://en.wikipedia.org/wiki/Cycloserine "Cycloserine") [Fabomotizole](https://en.wikipedia.org/wiki/Fabomotizole "Fabomotizole") [Hydroxyzine](https://en.wikipedia.org/wiki/Hydroxyzine "Hydroxyzine") [Lorpiprazole](https://en.wikipedia.org/wiki/Lorpiprazole "Lorpiprazole") [Mebicar](https://en.wikipedia.org/wiki/Mebicar "Mebicar") [Mepiprazole](https://en.wikipedia.org/wiki/Mepiprazole "Mepiprazole") [Nicotine](https://en.wikipedia.org/wiki/Nicotine "Nicotine") ([tobacco](https://en.wikipedia.org/wiki/Tobacco "Tobacco")) [Opipramol](https://en.wikipedia.org/wiki/Opipramol "Opipramol") [Oxaflozane](https://en.wikipedia.org/wiki/Oxaflozane "Oxaflozane")‡ [Phenaglycodol](https://en.wikipedia.org/wiki/Phenaglycodol "Phenaglycodol") [Phenibut](https://en.wikipedia.org/wiki/Phenibut "Phenibut") [Picamilon](https://en.wikipedia.org/wiki/Picamilon "Picamilon") [Selank](https://en.wikipedia.org/wiki/Selank "Selank") [Tiagabine](https://en.wikipedia.org/wiki/Tiagabine "Tiagabine") [Tofisopam](https://en.wikipedia.org/wiki/Tofisopam "Tofisopam") [Validolum](https://en.wikipedia.org/wiki/Validolum "Validolum") | | \#[WHO-EM](https://en.wikipedia.org/wiki/WHO_Model_List_of_Essential_Medicines "WHO Model List of Essential Medicines") ‡[Withdrawn](https://en.wikipedia.org/wiki/List_of_withdrawn_drugs "List of withdrawn drugs") from market [Clinical trials](https://en.wikipedia.org/wiki/Clinical_trial "Clinical trial"): †[Phase III](https://en.wikipedia.org/wiki/Phases_of_clinical_research#Phase_III "Phases of clinical research") §Never to phase III | | | [v](https://en.wikipedia.org/wiki/Template:OCD_medications "Template:OCD medications") [t](https://en.wikipedia.org/wiki/Template_talk:OCD_medications "Template talk:OCD medications") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:OCD_medications "Special:EditPage/Template:OCD medications")[OCD medications](https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_disorder#Medication "Obsessive–compulsive disorder") | | |---|---| | [Antidepressants](https://en.wikipedia.org/wiki/Antidepressant "Antidepressant") | [SSRIs](https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitors "Selective serotonin reuptake inhibitors") Tooltip Selective serotonin reuptake inhibitors ([citalopram](https://en.wikipedia.org/wiki/Citalopram "Citalopram"), [escitalopram](https://en.wikipedia.org/wiki/Escitalopram "Escitalopram"), [fluoxetine](https://en.wikipedia.org/wiki/Fluoxetine "Fluoxetine"), [fluvoxamine](https://en.wikipedia.org/wiki/Fluvoxamine "Fluvoxamine"), [paroxetine](https://en.wikipedia.org/wiki/Paroxetine "Paroxetine"), [sertraline]()) [SNRIs](https://en.wikipedia.org/wiki/Serotonin-norepinephrine_reuptake_inhibitors "Serotonin-norepinephrine reuptake inhibitors") Tooltip Serotonin-norepinephrine reuptake inhibitors ([venlafaxine](https://en.wikipedia.org/wiki/Venlafaxine "Venlafaxine")) [TCAs](https://en.wikipedia.org/wiki/Tricyclic_antidepressants "Tricyclic antidepressants") Tooltip Tricyclic antidepressants ([clomipramine](https://en.wikipedia.org/wiki/Clomipramine "Clomipramine")) | | Others | [Typical antipsychotics](https://en.wikipedia.org/wiki/Typical_antipsychotic "Typical antipsychotic") ([haloperidol](https://en.wikipedia.org/wiki/Haloperidol "Haloperidol")) [Atypical antipsychotics](https://en.wikipedia.org/wiki/Atypical_antipsychotic "Atypical antipsychotic") ([aripiprazole](https://en.wikipedia.org/wiki/Aripiprazole "Aripiprazole"), [olanzapine](https://en.wikipedia.org/wiki/Olanzapine "Olanzapine"), [quetiapine](https://en.wikipedia.org/wiki/Quetiapine "Quetiapine"), [risperidone](https://en.wikipedia.org/wiki/Risperidone "Risperidone")) | | [v](https://en.wikipedia.org/wiki/Template:Drugs_for_erectile_dysfunction_and_premature_ejaculation "Template:Drugs for erectile dysfunction and premature ejaculation") [t](https://en.wikipedia.org/wiki/Template_talk:Drugs_for_erectile_dysfunction_and_premature_ejaculation "Template talk:Drugs for erectile dysfunction and premature ejaculation") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Drugs_for_erectile_dysfunction_and_premature_ejaculation "Special:EditPage/Template:Drugs for erectile dysfunction and premature ejaculation")Drugs for [erectile dysfunction](https://en.wikipedia.org/wiki/Erectile_dysfunction "Erectile dysfunction") ([G04BE](https://en.wikipedia.org/wiki/ATC_code_G04#G04BE "ATC code G04")) and [premature ejaculation](https://en.wikipedia.org/wiki/Premature_ejaculation "Premature ejaculation") | | |---|---| | [Erectile dysfunction](https://en.wikipedia.org/wiki/Erectile_dysfunction "Erectile dysfunction") | | | | | | [Prostaglandins](https://en.wikipedia.org/wiki/Prostaglandin "Prostaglandin") (E) | [Alprostadil (PGE1)](https://en.wikipedia.org/wiki/Prostaglandin_E1 "Prostaglandin E1") | | [PDE5 inhibitors](https://en.wikipedia.org/wiki/PDE5_inhibitor "PDE5 inhibitor") | [Avanafil](https://en.wikipedia.org/wiki/Avanafil "Avanafil") [Lodenafil](https://en.wikipedia.org/wiki/Lodenafil "Lodenafil") [Mirodenafil](https://en.wikipedia.org/wiki/Mirodenafil "Mirodenafil") [Sildenafil](https://en.wikipedia.org/wiki/Sildenafil "Sildenafil") [Simmerafil](https://en.wikipedia.org/wiki/Simmerafil "Simmerafil") [Tadalafil](https://en.wikipedia.org/wiki/Tadalafil "Tadalafil") [Udenafil](https://en.wikipedia.org/wiki/Udenafil "Udenafil") [Vardenafil](https://en.wikipedia.org/wiki/Vardenafil "Vardenafil") | | [Alpha blockers](https://en.wikipedia.org/wiki/Alpha_blocker "Alpha blocker") | [Moxisylyte (thymoxamine)](https://en.wikipedia.org/wiki/Moxisylyte "Moxisylyte") [Phentolamine](https://en.wikipedia.org/wiki/Phentolamine "Phentolamine") [Rauwolscine](https://en.wikipedia.org/wiki/Rauwolscine "Rauwolscine") [Yohimbine](https://en.wikipedia.org/wiki/Yohimbine "Yohimbine") | | [Dopamine agonists](https://en.wikipedia.org/wiki/Dopamine_agonist "Dopamine agonist") | [Apomorphine](https://en.wikipedia.org/wiki/Apomorphine "Apomorphine") | | [Melanocortin agonists](https://en.wikipedia.org/wiki/Melanocortin "Melanocortin") | [Bremelanotide](https://en.wikipedia.org/wiki/Bremelanotide "Bremelanotide") [Melanotan II](https://en.wikipedia.org/wiki/Melanotan_II "Melanotan II") [PL-6983](https://en.wikipedia.org/wiki/PL-6983 "PL-6983") | | Others | [Afrodor](https://en.wikipedia.org/wiki/Afrodor "Afrodor") ([acecarbromal](https://en.wikipedia.org/wiki/Acecarbromal "Acecarbromal"), [quebracho](https://en.wikipedia.org/wiki/Aspidosperma_quebracho-blanco "Aspidosperma quebracho-blanco"), [vitamin E](https://en.wikipedia.org/wiki/Vitamin_E "Vitamin E")) [Papaverine](https://en.wikipedia.org/wiki/Papaverine "Papaverine") [Trazodone](https://en.wikipedia.org/wiki/Trazodone "Trazodone") | | [Premature ejaculation](https://en.wikipedia.org/wiki/Premature_ejaculation "Premature ejaculation") | | | | | | [SRIs](https://en.wikipedia.org/wiki/Serotonin_reuptake_inhibitor "Serotonin reuptake inhibitor")/[SSRIs](https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor "Selective serotonin reuptake inhibitor") | [Dapoxetine](https://en.wikipedia.org/wiki/Dapoxetine "Dapoxetine") *Off-label:* [Citalopram](https://en.wikipedia.org/wiki/Citalopram "Citalopram") [Clomipramine](https://en.wikipedia.org/wiki/Clomipramine "Clomipramine") [Escitalopram](https://en.wikipedia.org/wiki/Escitalopram "Escitalopram") [Fluoxetine](https://en.wikipedia.org/wiki/Fluoxetine "Fluoxetine") [Paroxetine](https://en.wikipedia.org/wiki/Paroxetine "Paroxetine") [Sertraline]() [Tramadol](https://en.wikipedia.org/wiki/Tramadol "Tramadol") *Others:* [Kanna](https://en.wikipedia.org/wiki/Mesembryanthemum_tortuosum "Mesembryanthemum tortuosum") | | [Oxytocin](https://en.wikipedia.org/wiki/Oxytocin_receptor "Oxytocin receptor") [antagonists](https://en.wikipedia.org/wiki/Receptor_antagonist "Receptor antagonist") | [Cligosiban](https://en.wikipedia.org/wiki/Cligosiban "Cligosiban") [Epelsiban](https://en.wikipedia.org/wiki/Epelsiban "Epelsiban") | | [Local anesthetics](https://en.wikipedia.org/wiki/Local_anesthetic "Local anesthetic") | [Benzocaine](https://en.wikipedia.org/wiki/Benzocaine "Benzocaine") [Lidocaine](https://en.wikipedia.org/wiki/Lidocaine "Lidocaine") [Lidocaine/prilocaine](https://en.wikipedia.org/wiki/Lidocaine/prilocaine "Lidocaine/prilocaine") | | ***See also:** [Sexual dysfunction medications](https://en.wikipedia.org/wiki/Template:Sexual_dysfunction_medications "Template:Sexual dysfunction medications")* *[List of investigational sexual dysfunction drugs](https://en.wikipedia.org/wiki/List_of_investigational_sexual_dysfunction_drugs "List of investigational sexual dysfunction drugs")* | | | [v](https://en.wikipedia.org/wiki/Template:Monoamine_reuptake_inhibitors "Template:Monoamine reuptake inhibitors") [t](https://en.wikipedia.org/wiki/Template_talk:Monoamine_reuptake_inhibitors "Template talk:Monoamine reuptake inhibitors") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Monoamine_reuptake_inhibitors "Special:EditPage/Template:Monoamine reuptake inhibitors")[Monoamine reuptake inhibitors](https://en.wikipedia.org/wiki/Monoamine_reuptake_inhibitor "Monoamine reuptake inhibitor") | | |---|---| | [DAT](https://en.wikipedia.org/wiki/Dopamine_transporter "Dopamine transporter")Tooltip Dopamine transporter ( [DRIs](https://en.wikipedia.org/wiki/Dopamine_reuptake_inhibitors "Dopamine reuptake inhibitors") Tooltip Dopamine reuptake inhibitors) | | | | | | *Piperazines:* [DBL-583](https://en.wikipedia.org/wiki/DBL-583 "DBL-583") [GBR-12783](https://en.wikipedia.org/wiki/GBR-12783 "GBR-12783") [GBR-12935](https://en.wikipedia.org/wiki/GBR-12935 "GBR-12935") [GBR-13069](https://en.wikipedia.org/wiki/GBR-13069 "GBR-13069") [GBR-13098](https://en.wikipedia.org/wiki/GBR-13098 "GBR-13098") [JJC8-088](https://en.wikipedia.org/wiki/JJC8-088 "JJC8-088") [Nefazodone](https://en.wikipedia.org/wiki/Nefazodone "Nefazodone") [Vanoxerine](https://en.wikipedia.org/wiki/Vanoxerine "Vanoxerine") | | | *Piperidines:* [4-Fluoropethidine](https://en.wikipedia.org/wiki/4-Fluoropethidine "4-Fluoropethidine") [Benocyclidine (BTCP)](https://en.wikipedia.org/wiki/Benocyclidine "Benocyclidine") [Desoxypipradrol](https://en.wikipedia.org/wiki/Desoxypipradrol "Desoxypipradrol") [Dexmethylphenidate](https://en.wikipedia.org/wiki/Dexmethylphenidate "Dexmethylphenidate") [Difemetorex](https://en.wikipedia.org/wiki/Difemetorex "Difemetorex") [Ethylphenidate](https://en.wikipedia.org/wiki/Ethylphenidate "Ethylphenidate") [HDMP-28](https://en.wikipedia.org/wiki/HDMP-28 "HDMP-28") [Methylphenidate](https://en.wikipedia.org/wiki/Methylphenidate "Methylphenidate") [Pethidine (meperidine)](https://en.wikipedia.org/wiki/Pethidine "Pethidine") [Phencyclidine](https://en.wikipedia.org/wiki/Phencyclidine "Phencyclidine") [Pipradrol](https://en.wikipedia.org/wiki/Pipradrol "Pipradrol") [Serdexmethylphenidate](https://en.wikipedia.org/wiki/Serdexmethylphenidate "Serdexmethylphenidate") [Tenocyclidine](https://en.wikipedia.org/wiki/Tenocyclidine "Tenocyclidine") | | | *Pyrrolidines:* [Diphenylprolinol](https://en.wikipedia.org/wiki/Diphenylprolinol "Diphenylprolinol") [MDPV](https://en.wikipedia.org/wiki/Methylenedioxypyrovalerone "Methylenedioxypyrovalerone") [Naphyrone](https://en.wikipedia.org/wiki/Naphyrone "Naphyrone") [Prolintane](https://en.wikipedia.org/wiki/Prolintane "Prolintane") [Pyrovalerone](https://en.wikipedia.org/wiki/Pyrovalerone "Pyrovalerone") | | | *Tropanes:* [Altropane](https://en.wikipedia.org/wiki/Altropane "Altropane") [Benzatropine (benztropine)](https://en.wikipedia.org/wiki/Benzatropine "Benzatropine") [Brasofensine](https://en.wikipedia.org/wiki/Brasofensine "Brasofensine") [CFT](https://en.wikipedia.org/wiki/WIN_35428 "WIN 35428") [Cocaine](https://en.wikipedia.org/wiki/Cocaine "Cocaine") [Dichloropane](https://en.wikipedia.org/wiki/Dichloropane "Dichloropane") [Difluoropine](https://en.wikipedia.org/wiki/Difluoropine "Difluoropine") [Etybenzatropine (ethybenztropine)](https://en.wikipedia.org/wiki/Etybenzatropine "Etybenzatropine") [FE-ÎČ-CPPIT](https://en.wikipedia.org/wiki/FE-%CE%B2-CPPIT "FE-ÎČ-CPPIT") [FP-ÎČ-CPPIT](https://en.wikipedia.org/wiki/FP-%CE%B2-CPPIT "FP-ÎČ-CPPIT") [Ioflupane (123I)](https://en.wikipedia.org/wiki/Ioflupane_\(123I\) "Ioflupane (123I)") [RTI-55](https://en.wikipedia.org/wiki/RTI-55 "RTI-55") [RTI-112](https://en.wikipedia.org/wiki/RTI-112 "RTI-112") [RTI-113](https://en.wikipedia.org/wiki/RTI-113 "RTI-113") [RTI-121](https://en.wikipedia.org/wiki/RTI-121 "RTI-121") [RTI-126](https://en.wikipedia.org/wiki/RTI-126 "RTI-126") [RTI-150](https://en.wikipedia.org/wiki/RTI-150 "RTI-150") [RTI-177](https://en.wikipedia.org/wiki/RTI-177 "RTI-177") [RTI-229](https://en.wikipedia.org/wiki/RTI-229 "RTI-229") [RTI-336](https://en.wikipedia.org/wiki/\(-\)-2%CE%B2-\(3-\(4-Methylphenyl\)isoxazol-5-yl\)-3%CE%B2-\(4-chlorophenyl\)tropane "(-)-2ÎČ-(3-(4-Methylphenyl)isoxazol-5-yl)-3ÎČ-(4-chlorophenyl)tropane") [Tesofensine](https://en.wikipedia.org/wiki/Tesofensine "Tesofensine") [Troparil](https://en.wikipedia.org/wiki/Troparil "Troparil") [Tropoxane](https://en.wikipedia.org/wiki/Tropoxane "Tropoxane") [WF-11](https://en.wikipedia.org/wiki/2%CE%B2-Propanoyl-3%CE%B2-\(4-tolyl\)-tropane "2ÎČ-Propanoyl-3ÎČ-(4-tolyl)-tropane") [WF-23](https://en.wikipedia.org/wiki/2%CE%B2-Propanoyl-3%CE%B2-\(2-naphthyl\)-tropane "2ÎČ-Propanoyl-3ÎČ-(2-naphthyl)-tropane") [WF-31](https://en.wikipedia.org/wiki/2-Propanoyl-3-\(4-isopropylphenyl\)-tropane "2-Propanoyl-3-(4-isopropylphenyl)-tropane") [WF-33](https://en.wikipedia.org/wiki/2%CE%B1-\(Propanoyl\)-3%CE%B2-\(2-\(6-methoxynaphthyl\)\)-tropane "2α-(Propanoyl)-3ÎČ-(2-(6-methoxynaphthyl))-tropane") | | | *Others:* [Adrafinil](https://en.wikipedia.org/wiki/Adrafinil "Adrafinil") [Amifitadine](https://en.wikipedia.org/wiki/Amifitadine "Amifitadine") [Armodafinil](https://en.wikipedia.org/wiki/Armodafinil "Armodafinil") [Amfonelic acid](https://en.wikipedia.org/wiki/Amfonelic_acid "Amfonelic acid") [Amineptine](https://en.wikipedia.org/wiki/Amineptine "Amineptine") [Ansofaxine](https://en.wikipedia.org/wiki/Ansofaxine "Ansofaxine") [BTQ](https://en.wikipedia.org/wiki/Butyltolylquinuclidine "Butyltolylquinuclidine") [BTS 74,398](https://en.wikipedia.org/wiki/BTS_74,398 "BTS 74,398") [Bupropion](https://en.wikipedia.org/wiki/Bupropion "Bupropion") *[Chaenomeles speciosa](https://en.wikipedia.org/wiki/Chaenomeles_speciosa "Chaenomeles speciosa")* [Ciclazindol](https://en.wikipedia.org/wiki/Ciclazindol "Ciclazindol") [Dasotraline](https://en.wikipedia.org/wiki/Dasotraline "Dasotraline") [Desmethylsertraline](https://en.wikipedia.org/wiki/Desmethylsertraline "Desmethylsertraline") [Desmethylsibutramine (BTS-54354)](https://en.wikipedia.org/wiki/Desmethylsibutramine "Desmethylsibutramine") [Diclofensine](https://en.wikipedia.org/wiki/Diclofensine "Diclofensine") [Didesmethylsibutramine (BTS-54505)](https://en.wikipedia.org/wiki/Didesmethylsibutramine "Didesmethylsibutramine") [Dimethocaine](https://en.wikipedia.org/wiki/Dimethocaine "Dimethocaine") [Diphenylpyraline](https://en.wikipedia.org/wiki/Diphenylpyraline "Diphenylpyraline") [Dizocilpine (MK-801)](https://en.wikipedia.org/wiki/Dizocilpine "Dizocilpine") [DOV-102,677](https://en.wikipedia.org/wiki/DOV-102,677 "DOV-102,677") [DOV-216,303](https://en.wikipedia.org/wiki/DOV-216,303 "DOV-216,303") [Efavirenz](https://en.wikipedia.org/wiki/Efavirenz "Efavirenz") [Ephenidine](https://en.wikipedia.org/wiki/Ephenidine "Ephenidine") [Esketamine](https://en.wikipedia.org/wiki/Esketamine "Esketamine") [EXP-561](https://en.wikipedia.org/wiki/EXP-561 "EXP-561") [Fencamfamin](https://en.wikipedia.org/wiki/Fencamfamin "Fencamfamin") [Fezolamine](https://en.wikipedia.org/wiki/Fezolamine "Fezolamine") [Fluorenol](https://en.wikipedia.org/wiki/Fluorenol "Fluorenol") [GYKI-52895](https://en.wikipedia.org/wiki/GYKI-52895 "GYKI-52895") [Hydroxybupropion](https://en.wikipedia.org/wiki/Hydroxybupropion "Hydroxybupropion") [Indatraline](https://en.wikipedia.org/wiki/Indatraline "Indatraline") [Ketamine](https://en.wikipedia.org/wiki/Ketamine "Ketamine") [Lafadofensine](https://en.wikipedia.org/wiki/Lafadofensine "Lafadofensine") [Lefetamine](https://en.wikipedia.org/wiki/Lefetamine "Lefetamine") [Levophacetoperane](https://en.wikipedia.org/wiki/Levophacetoperane "Levophacetoperane") [Liafensine](https://en.wikipedia.org/wiki/Liafensine "Liafensine") [LR-5182](https://en.wikipedia.org/wiki/LR-5182 "LR-5182") [Manifaxine](https://en.wikipedia.org/wiki/Manifaxine "Manifaxine") [Mazindol](https://en.wikipedia.org/wiki/Mazindol "Mazindol") [Medifoxamine](https://en.wikipedia.org/wiki/Medifoxamine "Medifoxamine") [Mesocarb](https://en.wikipedia.org/wiki/Mesocarb "Mesocarb") [Metaphit](https://en.wikipedia.org/wiki/Metaphit "Metaphit") [MIN-117 (WF-516)](https://en.wikipedia.org/wiki/MIN-117 "MIN-117") [Modafinil](https://en.wikipedia.org/wiki/Modafinil "Modafinil") [Nefopam](https://en.wikipedia.org/wiki/Nefopam "Nefopam") [Nomifensine](https://en.wikipedia.org/wiki/Nomifensine "Nomifensine") [NS-2359](https://en.wikipedia.org/wiki/NS-2359 "NS-2359") [O-2172](https://en.wikipedia.org/wiki/O-2172 "O-2172") [Oroxylin A](https://en.wikipedia.org/wiki/Oroxylin_A "Oroxylin A") [Perafensine](https://en.wikipedia.org/wiki/Perafensine "Perafensine") [Pridefine](https://en.wikipedia.org/wiki/Pridefine "Pridefine") [Pudafensine](https://en.wikipedia.org/wiki/Pudafensine "Pudafensine") [Radafaxine](https://en.wikipedia.org/wiki/Radafaxine "Radafaxine") [Rimcazole](https://en.wikipedia.org/wiki/Rimcazole "Rimcazole") [Sertraline]() [Sibutramine](https://en.wikipedia.org/wiki/Sibutramine "Sibutramine") [Solriamfetol](https://en.wikipedia.org/wiki/Solriamfetol "Solriamfetol") [Tametraline](https://en.wikipedia.org/wiki/Tametraline "Tametraline") [Tedatioxetine](https://en.wikipedia.org/wiki/Tedatioxetine "Tedatioxetine") [Threohydrobupropion](https://en.wikipedia.org/wiki/Threohydrobupropion "Threohydrobupropion") [Tripelennamine](https://en.wikipedia.org/wiki/Tripelennamine "Tripelennamine") [Venlafaxine](https://en.wikipedia.org/wiki/Venlafaxine "Venlafaxine") | | | [NET](https://en.wikipedia.org/wiki/Norepinephrine_transporter "Norepinephrine transporter")Tooltip Norepinephrine transporter ( [NRIs](https://en.wikipedia.org/wiki/Norepinephrine_reuptake_inhibitors "Norepinephrine reuptake inhibitors") Tooltip Norepinephrine reuptake inhibitors) | | | | | | *Selective norepinephrine reuptake inhibitors:* [Amedalin](https://en.wikipedia.org/wiki/Amedalin "Amedalin") [Alseroxylon](https://en.wikipedia.org/wiki/Alseroxylon "Alseroxylon") [Ciclazindol](https://en.wikipedia.org/wiki/Ciclazindol "Ciclazindol") [Daledalin](https://en.wikipedia.org/wiki/Daledalin "Daledalin") [Edivoxetine](https://en.wikipedia.org/wiki/Edivoxetine "Edivoxetine") [Esreboxetine](https://en.wikipedia.org/wiki/Esreboxetine "Esreboxetine") [Lortalamine](https://en.wikipedia.org/wiki/Lortalamine "Lortalamine") [Mazindol](https://en.wikipedia.org/wiki/Mazindol "Mazindol") [Nisoxetine](https://en.wikipedia.org/wiki/Nisoxetine "Nisoxetine") [Reboxetine](https://en.wikipedia.org/wiki/Reboxetine "Reboxetine") [Talopram](https://en.wikipedia.org/wiki/Talopram "Talopram") [Talsupram](https://en.wikipedia.org/wiki/Talsupram "Talsupram") [Tandamine](https://en.wikipedia.org/wiki/Tandamine "Tandamine") [Teniloxazine](https://en.wikipedia.org/wiki/Teniloxazine "Teniloxazine") [Viloxazine](https://en.wikipedia.org/wiki/Viloxazine "Viloxazine") | | | *Norepinephrine–dopamine reuptake inhibitors:* [Amineptine](https://en.wikipedia.org/wiki/Amineptine "Amineptine") [Bupropion](https://en.wikipedia.org/wiki/Bupropion "Bupropion") [Fencamine](https://en.wikipedia.org/wiki/Fencamine "Fencamine") [Fencamfamin](https://en.wikipedia.org/wiki/Fencamfamin "Fencamfamin") [Hydroxybupropion](https://en.wikipedia.org/wiki/Hydroxybupropion "Hydroxybupropion") [Lefetamine](https://en.wikipedia.org/wiki/Lefetamine "Lefetamine") [Levophacetoperane](https://en.wikipedia.org/wiki/Levophacetoperane "Levophacetoperane") [LR-5182](https://en.wikipedia.org/wiki/LR-5182 "LR-5182") [Manifaxine](https://en.wikipedia.org/wiki/Manifaxine "Manifaxine") [Methylphenidate](https://en.wikipedia.org/wiki/Methylphenidate "Methylphenidate") [Nomifensine](https://en.wikipedia.org/wiki/Nomifensine "Nomifensine") [O-2172](https://en.wikipedia.org/wiki/O-2172 "O-2172") [Radafaxine](https://en.wikipedia.org/wiki/Radafaxine "Radafaxine") [Serdexmethylphenidate](https://en.wikipedia.org/wiki/Serdexmethylphenidate "Serdexmethylphenidate") [Solriamfetol](https://en.wikipedia.org/wiki/Solriamfetol "Solriamfetol") | | | *Serotonin–norepinephrine reuptake inhibitors:* [Atomoxetine (tomoxetine)](https://en.wikipedia.org/wiki/Atomoxetine "Atomoxetine") [CP-39,332](https://en.wikipedia.org/wiki/CP-39,332 "CP-39,332") [Desvenlafaxine](https://en.wikipedia.org/wiki/Desvenlafaxine "Desvenlafaxine") [Duloxetine](https://en.wikipedia.org/wiki/Duloxetine "Duloxetine") [Eclanamine](https://en.wikipedia.org/wiki/Eclanamine "Eclanamine") [Levomilnacipran](https://en.wikipedia.org/wiki/Levomilnacipran "Levomilnacipran") [McN5652](https://en.wikipedia.org/wiki/McN5652 "McN5652") [Milnacipran](https://en.wikipedia.org/wiki/Milnacipran "Milnacipran") [N-Methyl-PPPA](https://en.wikipedia.org/wiki/N-Methyl-PPPA "N-Methyl-PPPA") [Nafenodone](https://en.wikipedia.org/w/index.php?title=Nafenodone&action=edit&redlink=1 "Nafenodone (page does not exist)") [PPPA](https://en.wikipedia.org/wiki/PPPA_\(drug\) "PPPA (drug)") [Tofenacin](https://en.wikipedia.org/wiki/Tofenacin "Tofenacin") [Venlafaxine](https://en.wikipedia.org/wiki/Venlafaxine "Venlafaxine") | | | *Serotonin–norepinephrine–dopamine reuptake inhibitors:* [3,3-Diphenylcyclobutanamine](https://en.wikipedia.org/wiki/3,3-Diphenylcyclobutanamine "3,3-Diphenylcyclobutanamine") [Amifitadine](https://en.wikipedia.org/wiki/Amifitadine "Amifitadine") [Ansofaxine](https://en.wikipedia.org/wiki/Ansofaxine "Ansofaxine") [Bicifadine](https://en.wikipedia.org/wiki/Bicifadine "Bicifadine") [Brasofensine](https://en.wikipedia.org/wiki/Brasofensine "Brasofensine") [Centanafadine](https://en.wikipedia.org/wiki/Centanafadine "Centanafadine") [Cocaine](https://en.wikipedia.org/wiki/Cocaine "Cocaine") [Dasotraline](https://en.wikipedia.org/wiki/Dasotraline "Dasotraline") [Desmethylsertraline](https://en.wikipedia.org/wiki/Desmethylsertraline "Desmethylsertraline") [Desmethylsibutramine (BTS-54354)](https://en.wikipedia.org/wiki/Desmethylsibutramine "Desmethylsibutramine") [Diclofensine](https://en.wikipedia.org/wiki/Diclofensine "Diclofensine") [Didesmethylsibutramine (BTS-54505)](https://en.wikipedia.org/wiki/Didesmethylsibutramine "Didesmethylsibutramine") [DOV-102677](https://en.wikipedia.org/wiki/DOV-102677 "DOV-102677") [DOV-216303](https://en.wikipedia.org/wiki/DOV-216303 "DOV-216303") [EXP-561](https://en.wikipedia.org/wiki/EXP-561 "EXP-561") [Fezolamine](https://en.wikipedia.org/wiki/Fezolamine "Fezolamine") [HDMP-28](https://en.wikipedia.org/wiki/HDMP-28 "HDMP-28") [HP-505](https://en.wikipedia.org/wiki/HP-505 "HP-505") [Indatraline](https://en.wikipedia.org/wiki/Indatraline "Indatraline") [JNJ-7925476](https://en.wikipedia.org/wiki/JNJ-7925476 "JNJ-7925476") [JZ-IV-10](https://en.wikipedia.org/wiki/JZ-IV-10 "JZ-IV-10") [Lafadofensine](https://en.wikipedia.org/wiki/Lafadofensine "Lafadofensine") [Liafensine](https://en.wikipedia.org/wiki/Liafensine "Liafensine") [Mazindol](https://en.wikipedia.org/wiki/Mazindol "Mazindol") [Naphyrone](https://en.wikipedia.org/wiki/Naphyrone "Naphyrone") [Nefazodone](https://en.wikipedia.org/wiki/Nefazodone "Nefazodone") [Nefopam](https://en.wikipedia.org/wiki/Nefopam "Nefopam") [NS-2359](https://en.wikipedia.org/wiki/NS-2359 "NS-2359") [Perafensine](https://en.wikipedia.org/wiki/Perafensine "Perafensine") [PRC200](https://en.wikipedia.org/wiki/PRC200 "PRC200") [Pridefine](https://en.wikipedia.org/wiki/Pridefine "Pridefine") [Pudafensine](https://en.wikipedia.org/wiki/Pudafensine "Pudafensine") [SEP-228431](https://en.wikipedia.org/w/index.php?title=SEP-228431&action=edit&redlink=1 "SEP-228431 (page does not exist)") [SEP-228432](https://en.wikipedia.org/w/index.php?title=SEP-228432&action=edit&redlink=1 "SEP-228432 (page does not exist)") [Sibutramine](https://en.wikipedia.org/wiki/Sibutramine "Sibutramine") [Tedatioxetine](https://en.wikipedia.org/wiki/Tedatioxetine "Tedatioxetine") [Tesofensine](https://en.wikipedia.org/wiki/Tesofensine "Tesofensine") [Threohydrobupropion](https://en.wikipedia.org/wiki/Threohydrobupropion "Threohydrobupropion") [Tropanes](https://en.wikipedia.org/wiki/Tropane "Tropane") (e.g., [cocaine](https://en.wikipedia.org/wiki/Cocaine "Cocaine")) | | | *Tricyclic antidepressants:* [Amitriptyline](https://en.wikipedia.org/wiki/Amitriptyline "Amitriptyline") [Butriptyline](https://en.wikipedia.org/wiki/Butriptyline "Butriptyline") [Cianopramine](https://en.wikipedia.org/wiki/Cianopramine "Cianopramine") [Clomipramine](https://en.wikipedia.org/wiki/Clomipramine "Clomipramine") [Desipramine](https://en.wikipedia.org/wiki/Desipramine "Desipramine") [Dosulepin (dothiepin)](https://en.wikipedia.org/wiki/Dosulepin "Dosulepin") [Doxepin](https://en.wikipedia.org/wiki/Doxepin "Doxepin") [Imipramine](https://en.wikipedia.org/wiki/Imipramine "Imipramine") [Lofepramine](https://en.wikipedia.org/wiki/Lofepramine "Lofepramine") [Melitracen](https://en.wikipedia.org/wiki/Melitracen "Melitracen") [Nortriptyline](https://en.wikipedia.org/wiki/Nortriptyline "Nortriptyline") [Protriptyline](https://en.wikipedia.org/wiki/Protriptyline "Protriptyline") [Trimipramine](https://en.wikipedia.org/wiki/Trimipramine "Trimipramine") | | | *Tetracyclic antidepressants:* [Amoxapine](https://en.wikipedia.org/wiki/Amoxapine "Amoxapine") [Maprotiline](https://en.wikipedia.org/wiki/Maprotiline "Maprotiline") [Mianserin](https://en.wikipedia.org/wiki/Mianserin "Mianserin") [Oxaprotiline](https://en.wikipedia.org/wiki/Oxaprotiline "Oxaprotiline") [Setiptiline](https://en.wikipedia.org/wiki/Setiptiline "Setiptiline") | | | *Others:* [Amezinium metilsulfate](https://en.wikipedia.org/wiki/Amezinium_metilsulfate "Amezinium metilsulfate") [Antihistamines](https://en.wikipedia.org/wiki/Histamine_antagonist "Histamine antagonist") (e.g., [brompheniramine](https://en.wikipedia.org/wiki/Brompheniramine "Brompheniramine"), [chlorphenamine](https://en.wikipedia.org/wiki/Chlorphenamine "Chlorphenamine"), [pheniramine](https://en.wikipedia.org/wiki/Pheniramine "Pheniramine"), [tripelennamine](https://en.wikipedia.org/wiki/Tripelennamine "Tripelennamine")) [Antipsychotics](https://en.wikipedia.org/wiki/Antipsychotic "Antipsychotic") (e.g., [loxapine](https://en.wikipedia.org/wiki/Loxapine "Loxapine"), [ziprasidone](https://en.wikipedia.org/wiki/Ziprasidone "Ziprasidone")) [Arylcyclohexylamines](https://en.wikipedia.org/wiki/Arylcyclohexylamine "Arylcyclohexylamine") (e.g., [ketamine](https://en.wikipedia.org/wiki/Ketamine "Ketamine"), [phencyclidine](https://en.wikipedia.org/wiki/Phencyclidine "Phencyclidine")) [Dopexamine](https://en.wikipedia.org/wiki/Dopexamine "Dopexamine") [Ephenidine](https://en.wikipedia.org/wiki/Ephenidine "Ephenidine") *[Ginkgo biloba](https://en.wikipedia.org/wiki/Ginkgo_biloba "Ginkgo biloba")* [Indeloxazine](https://en.wikipedia.org/wiki/Indeloxazine "Indeloxazine") [Nefazodone](https://en.wikipedia.org/wiki/Nefazodone "Nefazodone") [Opioids](https://en.wikipedia.org/wiki/Opioid "Opioid") (e.g., [desmetramadol](https://en.wikipedia.org/wiki/Desmetramadol "Desmetramadol"), [methadone](https://en.wikipedia.org/wiki/Methadone "Methadone"), [pethidine (meperidine)](https://en.wikipedia.org/wiki/Pethidine "Pethidine"), [tapentadol](https://en.wikipedia.org/wiki/Tapentadol "Tapentadol"), [tramadol](https://en.wikipedia.org/wiki/Tramadol "Tramadol"), [levorphanol](https://en.wikipedia.org/wiki/Levorphanol "Levorphanol")) | | | [SERT](https://en.wikipedia.org/wiki/Serotonin_transporter "Serotonin transporter")Tooltip Serotonin transporter ( [SRIs](https://en.wikipedia.org/wiki/Serotonin_reuptake_inhibitors "Serotonin reuptake inhibitors") Tooltip Serotonin reuptake inhibitors) | | | | | | *Selective serotonin reuptake inhibitors:* [6-Nitroquipazine](https://en.wikipedia.org/wiki/6-Nitroquipazine "6-Nitroquipazine") [Alaproclate](https://en.wikipedia.org/wiki/Alaproclate "Alaproclate") [Centpropazine](https://en.wikipedia.org/wiki/Centpropazine "Centpropazine") [Cericlamine](https://en.wikipedia.org/wiki/Cericlamine "Cericlamine") [Citalopram](https://en.wikipedia.org/wiki/Citalopram "Citalopram") [Dapoxetine](https://en.wikipedia.org/wiki/Dapoxetine "Dapoxetine") [Desmethylcitalopram](https://en.wikipedia.org/wiki/Desmethylcitalopram "Desmethylcitalopram") [Didesmethylcitalopram](https://en.wikipedia.org/wiki/Didesmethylcitalopram "Didesmethylcitalopram") [Escitalopram](https://en.wikipedia.org/wiki/Escitalopram "Escitalopram") [Femoxetine](https://en.wikipedia.org/wiki/Femoxetine "Femoxetine") [Fluoxetine](https://en.wikipedia.org/wiki/Fluoxetine "Fluoxetine") [Fluvoxamine](https://en.wikipedia.org/wiki/Fluvoxamine "Fluvoxamine") [Indalpine](https://en.wikipedia.org/wiki/Indalpine "Indalpine") [Ifoxetine](https://en.wikipedia.org/wiki/Ifoxetine "Ifoxetine") [Norfluoxetine](https://en.wikipedia.org/wiki/Norfluoxetine "Norfluoxetine") [Omiloxetine](https://en.wikipedia.org/wiki/Omiloxetine "Omiloxetine") [Panuramine](https://en.wikipedia.org/wiki/Panuramine "Panuramine") [Paroxetine](https://en.wikipedia.org/wiki/Paroxetine "Paroxetine") [PIM-35](https://en.wikipedia.org/wiki/PIM-35 "PIM-35") [Pirandamine](https://en.wikipedia.org/wiki/Pirandamine "Pirandamine") [RTI-353](https://en.wikipedia.org/wiki/RTI-353 "RTI-353") [Seproxetine](https://en.wikipedia.org/wiki/Seproxetine "Seproxetine") [Sertraline]() [Zimelidine](https://en.wikipedia.org/wiki/Zimelidine "Zimelidine") *Selective serotonin reuptake inhibitors and serotonin receptor modulators:* [Etoperidone](https://en.wikipedia.org/wiki/Etoperidone "Etoperidone") [Litoxetine](https://en.wikipedia.org/wiki/Litoxetine "Litoxetine") [Lubazodone](https://en.wikipedia.org/wiki/Lubazodone "Lubazodone") [LY-393558](https://en.wikipedia.org/wiki/LY-393558 "LY-393558") [Quipazine](https://en.wikipedia.org/wiki/Quipazine "Quipazine") [SB-649915](https://en.wikipedia.org/wiki/SB-649915 "SB-649915") [TGBA01AD](https://en.wikipedia.org/wiki/TGBA01AD "TGBA01AD") [Trazodone](https://en.wikipedia.org/wiki/Trazodone "Trazodone") [Vilazodone](https://en.wikipedia.org/wiki/Vilazodone "Vilazodone") [Vortioxetine](https://en.wikipedia.org/wiki/Vortioxetine "Vortioxetine") | | | *Serotonin–norepinephrine reuptake inhibitors:* [Atomoxetine (tomoxetine)](https://en.wikipedia.org/wiki/Atomoxetine "Atomoxetine") [Bicifadine](https://en.wikipedia.org/wiki/Bicifadine "Bicifadine") [CP-39332](https://en.wikipedia.org/w/index.php?title=CP-39332&action=edit&redlink=1 "CP-39332 (page does not exist)") [Desvenlafaxine](https://en.wikipedia.org/wiki/Desvenlafaxine "Desvenlafaxine") [Duloxetine](https://en.wikipedia.org/wiki/Duloxetine "Duloxetine") [Eclanamine](https://en.wikipedia.org/wiki/Eclanamine "Eclanamine") [Levomilnacipran](https://en.wikipedia.org/wiki/Levomilnacipran "Levomilnacipran") [McN5652](https://en.wikipedia.org/wiki/McN5652 "McN5652") [Milnacipran](https://en.wikipedia.org/wiki/Milnacipran "Milnacipran") [N-Methyl-PPPA](https://en.wikipedia.org/wiki/N-Methyl-PPPA "N-Methyl-PPPA") [PPPA](https://en.wikipedia.org/wiki/PPPA_\(drug\) "PPPA (drug)") [Tofenacin](https://en.wikipedia.org/wiki/Tofenacin "Tofenacin") [Venlafaxine](https://en.wikipedia.org/wiki/Venlafaxine "Venlafaxine") | | | *Serotonin–norepinephrine–dopamine reuptake inhibitors:* [3,3-Diphenylcyclobutanamine](https://en.wikipedia.org/wiki/3,3-Diphenylcyclobutanamine "3,3-Diphenylcyclobutanamine") [Amifitadine](https://en.wikipedia.org/wiki/Amifitadine "Amifitadine") [Ansofaxine](https://en.wikipedia.org/wiki/Ansofaxine "Ansofaxine") [Bicifadine](https://en.wikipedia.org/wiki/Bicifadine "Bicifadine") [Brasofensine](https://en.wikipedia.org/wiki/Brasofensine "Brasofensine") [Centanafadine](https://en.wikipedia.org/wiki/Centanafadine "Centanafadine") [Cocaine](https://en.wikipedia.org/wiki/Cocaine "Cocaine") [Dasotraline](https://en.wikipedia.org/wiki/Dasotraline "Dasotraline") [Desmethylsertraline](https://en.wikipedia.org/wiki/Desmethylsertraline "Desmethylsertraline") [Desmethylsibutramine (BTS-54354)](https://en.wikipedia.org/wiki/Desmethylsibutramine "Desmethylsibutramine") [Diclofensine](https://en.wikipedia.org/wiki/Diclofensine "Diclofensine") [Didesmethylsibutramine (BTS-54505)](https://en.wikipedia.org/wiki/Didesmethylsibutramine "Didesmethylsibutramine") [DOV-102677](https://en.wikipedia.org/wiki/DOV-102677 "DOV-102677") [DOV-216303](https://en.wikipedia.org/wiki/DOV-216303 "DOV-216303") [EXP-561](https://en.wikipedia.org/wiki/EXP-561 "EXP-561") [Fezolamine](https://en.wikipedia.org/wiki/Fezolamine "Fezolamine") [HDMP-28](https://en.wikipedia.org/wiki/HDMP-28 "HDMP-28") [HP-505](https://en.wikipedia.org/wiki/HP-505 "HP-505") [Indatraline](https://en.wikipedia.org/wiki/Indatraline "Indatraline") [JNJ-7925476](https://en.wikipedia.org/wiki/JNJ-7925476 "JNJ-7925476") [JZ-IV-10](https://en.wikipedia.org/wiki/JZ-IV-10 "JZ-IV-10") [Lafadofensine](https://en.wikipedia.org/wiki/Lafadofensine "Lafadofensine") [Liafensine](https://en.wikipedia.org/wiki/Liafensine "Liafensine") [Mazindol](https://en.wikipedia.org/wiki/Mazindol "Mazindol") [Naphyrone](https://en.wikipedia.org/wiki/Naphyrone "Naphyrone") [Nefazodone](https://en.wikipedia.org/wiki/Nefazodone "Nefazodone") [Nefopam](https://en.wikipedia.org/wiki/Nefopam "Nefopam") [NS-2359](https://en.wikipedia.org/wiki/NS-2359 "NS-2359") [Perafensine](https://en.wikipedia.org/wiki/Perafensine "Perafensine") [PRC200](https://en.wikipedia.org/wiki/PRC200 "PRC200") [Pridefine](https://en.wikipedia.org/wiki/Pridefine "Pridefine") [Pudafensine](https://en.wikipedia.org/wiki/Pudafensine "Pudafensine") [SEP-228431](https://en.wikipedia.org/w/index.php?title=SEP-228431&action=edit&redlink=1 "SEP-228431 (page does not exist)") [SEP-228432](https://en.wikipedia.org/w/index.php?title=SEP-228432&action=edit&redlink=1 "SEP-228432 (page does not exist)") [Sibutramine](https://en.wikipedia.org/wiki/Sibutramine "Sibutramine") [Tedatioxetine](https://en.wikipedia.org/wiki/Tedatioxetine "Tedatioxetine") [Tesofensine](https://en.wikipedia.org/wiki/Tesofensine "Tesofensine") [Threohydrobupropion](https://en.wikipedia.org/wiki/Threohydrobupropion "Threohydrobupropion") [Tropanes](https://en.wikipedia.org/wiki/Tropane "Tropane") (e.g., [cocaine](https://en.wikipedia.org/wiki/Cocaine "Cocaine")) | | | *Tricyclic antidepressants:* [Amitriptyline](https://en.wikipedia.org/wiki/Amitriptyline "Amitriptyline") [Cianopramine](https://en.wikipedia.org/wiki/Cianopramine "Cianopramine") [Clomipramine](https://en.wikipedia.org/wiki/Clomipramine "Clomipramine") [Cyanodothiepin](https://en.wikipedia.org/wiki/Cyanodothiepin "Cyanodothiepin") [Desipramine](https://en.wikipedia.org/wiki/Desipramine "Desipramine") [Dosulepin (dothiepin)](https://en.wikipedia.org/wiki/Dosulepin "Dosulepin") [Doxepin](https://en.wikipedia.org/wiki/Doxepin "Doxepin") [Imipramine](https://en.wikipedia.org/wiki/Imipramine "Imipramine") [Lofepramine](https://en.wikipedia.org/wiki/Lofepramine "Lofepramine") [Nortriptyline](https://en.wikipedia.org/wiki/Nortriptyline "Nortriptyline") [Pipofezine](https://en.wikipedia.org/wiki/Pipofezine "Pipofezine") [Protriptyline](https://en.wikipedia.org/wiki/Protriptyline "Protriptyline") | | | *Others:* [A-80426](https://en.wikipedia.org/w/index.php?title=A-80426&action=edit&redlink=1 "A-80426 (page does not exist)") [Amoxapine](https://en.wikipedia.org/wiki/Amoxapine "Amoxapine") [Antihistamines](https://en.wikipedia.org/wiki/Antihistamine "Antihistamine") (e.g., [brompheniramine](https://en.wikipedia.org/wiki/Brompheniramine "Brompheniramine"), [chlorphenamine](https://en.wikipedia.org/wiki/Chlorphenamine "Chlorphenamine"), [dimenhydrinate](https://en.wikipedia.org/wiki/Dimenhydrinate "Dimenhydrinate"), [diphenhydramine](https://en.wikipedia.org/wiki/Diphenhydramine "Diphenhydramine"), [mepyramine (pyrilamine)](https://en.wikipedia.org/wiki/Mepyramine "Mepyramine"), [pheniramine](https://en.wikipedia.org/wiki/Pheniramine "Pheniramine"), [tripelennamine](https://en.wikipedia.org/wiki/Tripelennamine "Tripelennamine")) [Antipsychotics](https://en.wikipedia.org/wiki/Antipsychotic "Antipsychotic") (e.g., [loxapine](https://en.wikipedia.org/wiki/Loxapine "Loxapine"), [ziprasidone](https://en.wikipedia.org/wiki/Ziprasidone "Ziprasidone")) [Arylcyclohexylamines](https://en.wikipedia.org/wiki/Arylcyclohexylamine "Arylcyclohexylamine") (e.g., [3-MeO-PCP](https://en.wikipedia.org/wiki/3-MeO-PCP "3-MeO-PCP"), [esketamine](https://en.wikipedia.org/wiki/Esketamine "Esketamine"), [ketamine](https://en.wikipedia.org/wiki/Ketamine "Ketamine"), [methoxetamine](https://en.wikipedia.org/wiki/Methoxetamine "Methoxetamine"), [phencyclidine](https://en.wikipedia.org/wiki/Phencyclidine "Phencyclidine")) [Cyclobenzaprine](https://en.wikipedia.org/wiki/Cyclobenzaprine "Cyclobenzaprine") [Delucemine](https://en.wikipedia.org/wiki/Delucemine "Delucemine") [Dextromethorphan](https://en.wikipedia.org/wiki/Dextromethorphan "Dextromethorphan") [Dextrorphan](https://en.wikipedia.org/wiki/Dextrorphan "Dextrorphan") [Efavirenz](https://en.wikipedia.org/wiki/Efavirenz "Efavirenz") [Hypidone](https://en.wikipedia.org/wiki/Hypidone "Hypidone") [Medifoxamine](https://en.wikipedia.org/wiki/Medifoxamine "Medifoxamine") [Mesembrine](https://en.wikipedia.org/wiki/Mesembrine "Mesembrine") [Mifepristone](https://en.wikipedia.org/wiki/Mifepristone "Mifepristone") [MIN-117 (WF-516)](https://en.wikipedia.org/wiki/MIN-117 "MIN-117") [N-Me-5-HT](https://en.wikipedia.org/wiki/N-Methylserotonin "N-Methylserotonin") [Opioids](https://en.wikipedia.org/wiki/Opioid "Opioid") (e.g., [dextropropoxyphene](https://en.wikipedia.org/wiki/Dextropropoxyphene "Dextropropoxyphene"), [methadone](https://en.wikipedia.org/wiki/Methadone "Methadone"), [pethidine (meperidine)](https://en.wikipedia.org/wiki/Pethidine "Pethidine"), [levorphanol](https://en.wikipedia.org/wiki/Levorphanol "Levorphanol"), [tapentadol](https://en.wikipedia.org/wiki/Tapentadol "Tapentadol"), [tramadol](https://en.wikipedia.org/wiki/Tramadol "Tramadol")) [Roxindole](https://en.wikipedia.org/wiki/Roxindole "Roxindole") | | | [VMATs](https://en.wikipedia.org/wiki/Vesicular_monoamine_transporters "Vesicular monoamine transporters")Tooltip Vesicular monoamine transporters | [Amiodarone](https://en.wikipedia.org/wiki/Amiodarone "Amiodarone") [Amphetamines](https://en.wikipedia.org/wiki/Substituted_amphetamine "Substituted amphetamine") (e.g., [amphetamine](https://en.wikipedia.org/wiki/Amphetamine "Amphetamine"), [methamphetamine](https://en.wikipedia.org/wiki/Methamphetamine "Methamphetamine"), [MDMA](https://en.wikipedia.org/wiki/MDMA "MDMA")) [APP](https://en.wikipedia.org/w/index.php?title=3-Amino-2-phenylpropene&action=edit&redlink=1 "3-Amino-2-phenylpropene (page does not exist)") [AZIK](https://en.wikipedia.org/w/index.php?title=7-Azido-8-iodoketanserin&action=edit&redlink=1 "7-Azido-8-iodoketanserin (page does not exist)") [Bietaserpine](https://en.wikipedia.org/wiki/Bietaserpine "Bietaserpine") [Deserpidine](https://en.wikipedia.org/wiki/Deserpidine "Deserpidine") [Deutetrabenazine](https://en.wikipedia.org/wiki/Deutetrabenazine "Deutetrabenazine") [Dihydrotetrabenazine](https://en.wikipedia.org/wiki/Dihydrotetrabenazine "Dihydrotetrabenazine") [Efavirenz](https://en.wikipedia.org/wiki/Efavirenz "Efavirenz") [GBR-12935](https://en.wikipedia.org/wiki/GBR-12935 "GBR-12935") [GZ-793A](https://en.wikipedia.org/w/index.php?title=GZ-793A&action=edit&redlink=1 "GZ-793A (page does not exist)") [Ibogaine](https://en.wikipedia.org/wiki/Ibogaine "Ibogaine") [Ketanserin](https://en.wikipedia.org/wiki/Ketanserin "Ketanserin") [Lobeline](https://en.wikipedia.org/wiki/Lobeline "Lobeline") [Methoxytetrabenazine](https://en.wikipedia.org/w/index.php?title=Methoxytetrabenazine&action=edit&redlink=1 "Methoxytetrabenazine (page does not exist)") [Reserpine](https://en.wikipedia.org/wiki/Reserpine "Reserpine") [Rose bengal](https://en.wikipedia.org/wiki/Rose_bengal "Rose bengal") [Tetrabenazine](https://en.wikipedia.org/wiki/Tetrabenazine "Tetrabenazine") [Valbenazine](https://en.wikipedia.org/wiki/Valbenazine "Valbenazine") [Vanoxerine (GBR-12909)](https://en.wikipedia.org/wiki/Vanoxerine "Vanoxerine") | | Others | *Unsorted:* [Cendifensine](https://en.wikipedia.org/wiki/Cendifensine "Cendifensine") *DAT enhancers:* [Luteolin](https://en.wikipedia.org/wiki/Luteolin "Luteolin") *DAT modulators:* *Agonist-like:* [SoRI-9804](https://en.wikipedia.org/wiki/SoRI-9804 "SoRI-9804") [SoRI-20040](https://en.wikipedia.org/w/index.php?title=SoRI-20040&action=edit&redlink=1 "SoRI-20040 (page does not exist)"); *Antagonist-like:* [SoRI-20041](https://en.wikipedia.org/wiki/SoRI-20041 "SoRI-20041") | | ***See also:** [Receptor/signaling modulators](https://en.wikipedia.org/wiki/Template:Receptor_modulators "Template:Receptor modulators") ‱ [Monoamine releasing agents](https://en.wikipedia.org/wiki/Template:Monoamine_releasing_agents "Template:Monoamine releasing agents") ‱ [Adrenergics](https://en.wikipedia.org/wiki/Template:Adrenergics "Template:Adrenergics") ‱ [Dopaminergics](https://en.wikipedia.org/wiki/Template:Dopaminergics "Template:Dopaminergics") ‱ [Serotonergics](https://en.wikipedia.org/wiki/Template:Serotonergics "Template:Serotonergics") ‱ [Monoamine metabolism modulators](https://en.wikipedia.org/wiki/Template:Monoamine_metabolism_modulators "Template:Monoamine metabolism modulators") ‱ [Monoamine neurotoxins](https://en.wikipedia.org/wiki/Template:Monoamine_neurotoxins "Template:Monoamine neurotoxins")* | | | [v](https://en.wikipedia.org/wiki/Template:Sigma_receptor_modulators "Template:Sigma receptor modulators") [t](https://en.wikipedia.org/wiki/Template_talk:Sigma_receptor_modulators "Template talk:Sigma receptor modulators") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Sigma_receptor_modulators "Special:EditPage/Template:Sigma receptor modulators")[Sigma receptor](https://en.wikipedia.org/wiki/Sigma_receptor "Sigma receptor") [modulators](https://en.wikipedia.org/wiki/Receptor_modulator "Receptor modulator") | | |---|---| | [σ1](https://en.wikipedia.org/wiki/Sigma-1_receptor "Sigma-1 receptor") | **Agonists:** [3-PPP](https://en.wikipedia.org/wiki/3-PPP "3-PPP") [4-PPBP](https://en.wikipedia.org/wiki/4-PPBP "4-PPBP") [5-MeO-DMT](https://en.wikipedia.org/wiki/5-MeO-DMT "5-MeO-DMT") [Alazocine (SKF-10047)](https://en.wikipedia.org/wiki/Alazocine "Alazocine") [Amantadine](https://en.wikipedia.org/wiki/Amantadine "Amantadine") [Arketamine](https://en.wikipedia.org/wiki/Arketamine "Arketamine") [BD-737](https://en.wikipedia.org/w/index.php?title=BD-737&action=edit&redlink=1 "BD-737 (page does not exist)") [BD-1052](https://en.wikipedia.org/wiki/BD-1052 "BD-1052") [Blarcamesine](https://en.wikipedia.org/wiki/Blarcamesine "Blarcamesine") [Captodiame](https://en.wikipedia.org/wiki/Captodiame "Captodiame") [Citalopram](https://en.wikipedia.org/wiki/Citalopram "Citalopram") [CGRP](https://en.wikipedia.org/wiki/Calcitonin_gene-related_peptide "Calcitonin gene-related peptide") Tooltip Calcitonin gene-related peptide [Cloperastine](https://en.wikipedia.org/wiki/Cloperastine "Cloperastine") [Cocaine](https://en.wikipedia.org/wiki/Cocaine "Cocaine") [Cutamesine (SA-4503)](https://en.wikipedia.org/wiki/Cutamesine "Cutamesine") [Cyclazocine](https://en.wikipedia.org/wiki/Cyclazocine "Cyclazocine") [Dehydroepiandrosterone (DHEA)](https://en.wikipedia.org/wiki/Dehydroepiandrosterone "Dehydroepiandrosterone") ([prasterone](https://en.wikipedia.org/wiki/Prasterone "Prasterone")) [Dehydroepiandrosterone sulfate (DHEA-S)](https://en.wikipedia.org/wiki/Dehydroepiandrosterone_sulfate "Dehydroepiandrosterone sulfate") ([prasterone sulfate](https://en.wikipedia.org/wiki/Prasterone_sulfate "Prasterone sulfate")) [Dextrallorphan](https://en.wikipedia.org/wiki/Dextrallorphan "Dextrallorphan") [Dextromethorphan (DXM)](https://en.wikipedia.org/wiki/Dextromethorphan "Dextromethorphan") [Dextrorphan (DXO)](https://en.wikipedia.org/wiki/Dextrorphan "Dextrorphan") [Dimemorfan](https://en.wikipedia.org/wiki/Dimemorfan "Dimemorfan") [Dimethyltryptamine (DMT)](https://en.wikipedia.org/wiki/Dimethyltryptamine "Dimethyltryptamine") [Ditolylguanidine (DTG)](https://en.wikipedia.org/wiki/Ditolylguanidine "Ditolylguanidine") [Donepezil](https://en.wikipedia.org/wiki/Donepezil "Donepezil") [Eliprodil](https://en.wikipedia.org/wiki/Eliprodil "Eliprodil") [Escitalopram](https://en.wikipedia.org/wiki/Escitalopram "Escitalopram") [Fabomotizole (afobazole)](https://en.wikipedia.org/wiki/Fabomotizole "Fabomotizole") [Fluoxetine](https://en.wikipedia.org/wiki/Fluoxetine "Fluoxetine") [Fluvoxamine](https://en.wikipedia.org/wiki/Fluvoxamine "Fluvoxamine") [Ifenprodil](https://en.wikipedia.org/wiki/Ifenprodil "Ifenprodil") [Igmesine (JO-1784)](https://en.wikipedia.org/wiki/Igmesine "Igmesine") [IPAB](https://en.wikipedia.org/w/index.php?title=IPAB_\(drug\)&action=edit&redlink=1 "IPAB (drug) (page does not exist)") [Ketamine](https://en.wikipedia.org/wiki/Ketamine "Ketamine") [L-687384](https://en.wikipedia.org/wiki/L-687384 "L-687384") [MDMA (midomafetamine)](https://en.wikipedia.org/wiki/MDMA "MDMA") [Memantine](https://en.wikipedia.org/wiki/Memantine "Memantine") [Methamphetamine](https://en.wikipedia.org/wiki/Methamphetamine "Methamphetamine") [Methoxetamine](https://en.wikipedia.org/wiki/Methoxetamine "Methoxetamine") [Methylphenidate](https://en.wikipedia.org/wiki/Methylphenidate "Methylphenidate") [Nepinalone](https://en.wikipedia.org/wiki/Nepinalone "Nepinalone") [Neuropeptide Y](https://en.wikipedia.org/wiki/Neuropeptide_Y "Neuropeptide Y") [Noscapine](https://en.wikipedia.org/wiki/Noscapine "Noscapine") [OPC-14523](https://en.wikipedia.org/w/index.php?title=OPC-14523&action=edit&redlink=1 "OPC-14523 (page does not exist)") [Opipramol](https://en.wikipedia.org/wiki/Opipramol "Opipramol") [Pentazocine](https://en.wikipedia.org/wiki/Pentazocine "Pentazocine") [Pentoxyverine (carbetapentane)](https://en.wikipedia.org/wiki/Pentoxyverine "Pentoxyverine") [PRE-084](https://en.wikipedia.org/wiki/PRE-084 "PRE-084") [Pregnenolone](https://en.wikipedia.org/wiki/Pregnenolone "Pregnenolone") [Pregnenolone sulfate](https://en.wikipedia.org/wiki/Pregnenolone_sulfate "Pregnenolone sulfate") [Pridopidine](https://en.wikipedia.org/wiki/Pridopidine "Pridopidine") [Racemethorphan (methorphan)](https://en.wikipedia.org/wiki/Racemethorphan "Racemethorphan") [Racemorphan (morphanol)](https://en.wikipedia.org/wiki/Racemorphan "Racemorphan") [UMB-23](https://en.wikipedia.org/w/index.php?title=UMB-23&action=edit&redlink=1 "UMB-23 (page does not exist)") [UMB-82](https://en.wikipedia.org/w/index.php?title=UMB-82&action=edit&redlink=1 "UMB-82 (page does not exist)") **Antagonists:** [3-PPP](https://en.wikipedia.org/wiki/3-PPP "3-PPP") [AC-927](https://en.wikipedia.org/wiki/AC-927 "AC-927") [BD-1008](https://en.wikipedia.org/wiki/BD-1008 "BD-1008") [BD-1031](https://en.wikipedia.org/wiki/BD-1031 "BD-1031") [BD-1047](https://en.wikipedia.org/wiki/BD-1047 "BD-1047") [BD-1060](https://en.wikipedia.org/wiki/BD-1060 "BD-1060") [BD-1063](https://en.wikipedia.org/wiki/BD-1063 "BD-1063") [BD-1067](https://en.wikipedia.org/wiki/BD-1067 "BD-1067") [BMY-14802 (BMS-181100)](https://en.wikipedia.org/wiki/BMY-14802 "BMY-14802") [CM-156](https://en.wikipedia.org/wiki/CM-156 "CM-156") [Dup-734](https://en.wikipedia.org/w/index.php?title=Dup-734&action=edit&redlink=1 "Dup-734 (page does not exist)") [E-5842](https://en.wikipedia.org/w/index.php?title=E-5842&action=edit&redlink=1 "E-5842 (page does not exist)") [E-52862 (S1RA)](https://en.wikipedia.org/wiki/E-52862 "E-52862") [Haloperidol](https://en.wikipedia.org/wiki/Haloperidol "Haloperidol") [LR-132](https://en.wikipedia.org/w/index.php?title=LR-132&action=edit&redlink=1 "LR-132 (page does not exist)") [LR-172](https://en.wikipedia.org/w/index.php?title=LR-172&action=edit&redlink=1 "LR-172 (page does not exist)") [MS-377](https://en.wikipedia.org/wiki/MS-377 "MS-377") [NE-100](https://en.wikipedia.org/wiki/NE-100 "NE-100") [NPC-16377](https://en.wikipedia.org/w/index.php?title=NPC-16377&action=edit&redlink=1 "NPC-16377 (page does not exist)") [Panamesine (EMD-57455)](https://en.wikipedia.org/wiki/Panamesine "Panamesine") [PD-144418](https://en.wikipedia.org/w/index.php?title=PD-144418&action=edit&redlink=1 "PD-144418 (page does not exist)") [Pentazocine](https://en.wikipedia.org/wiki/Pentazocine "Pentazocine") [Progesterone](https://en.wikipedia.org/wiki/Progesterone "Progesterone") [Rimcazole (BW-234U)](https://en.wikipedia.org/wiki/Rimcazole "Rimcazole") [Sertraline]() [SR-31742A](https://en.wikipedia.org/w/index.php?title=SR-31742A&action=edit&redlink=1 "SR-31742A (page does not exist)") **Allosteric modulators:** [Phenytoin](https://en.wikipedia.org/wiki/Phenytoin "Phenytoin"); *Positive:* [Methylphenylpiracetam](https://en.wikipedia.org/wiki/Methylphenylpiracetam "Methylphenylpiracetam") [SOMCL-668](https://en.wikipedia.org/w/index.php?title=SOMCL-668&action=edit&redlink=1 "SOMCL-668 (page does not exist)") **Unknown/unsorted:** [3-Methoxydextrallorphan](https://en.wikipedia.org/w/index.php?title=3-Methoxydextrallorphan&action=edit&redlink=1 "3-Methoxydextrallorphan (page does not exist)") [3-MeO-PCP](https://en.wikipedia.org/wiki/3-MeO-PCP "3-MeO-PCP") [4C-T-2](https://en.wikipedia.org/wiki/4C-T-2 "4C-T-2") [4-IBP](https://en.wikipedia.org/w/index.php?title=4-IBP&action=edit&redlink=1 "4-IBP (page does not exist)") [4-IPBS](https://en.wikipedia.org/w/index.php?title=4-IPBS&action=edit&redlink=1 "4-IPBS (page does not exist)") [4-MeO-PCP](https://en.wikipedia.org/wiki/4-MeO-PCP "4-MeO-PCP") [5-MeO-DALT](https://en.wikipedia.org/wiki/5-MeO-DALT "5-MeO-DALT") [5-MeO-DiPT](https://en.wikipedia.org/wiki/5-MeO-DiPT "5-MeO-DiPT") [Amitriptyline](https://en.wikipedia.org/wiki/Amitriptyline "Amitriptyline") [Azidopamil](https://en.wikipedia.org/w/index.php?title=Azidopamil&action=edit&redlink=1 "Azidopamil (page does not exist)") [Chlorpromazine](https://en.wikipedia.org/wiki/Chlorpromazine "Chlorpromazine") [Clemastine](https://en.wikipedia.org/wiki/Clemastine "Clemastine") [Clomipramine](https://en.wikipedia.org/wiki/Clomipramine "Clomipramine") [Clorgiline](https://en.wikipedia.org/wiki/Clorgiline "Clorgiline") [D-Deprenyl](https://en.wikipedia.org/wiki/D-Deprenyl "D-Deprenyl") [DiPT](https://en.wikipedia.org/wiki/N,N-Diisopropyltryptamine "N,N-Diisopropyltryptamine") Tooltip N,N-Diisopropyltryptamine [DPT](https://en.wikipedia.org/wiki/N,N-Dipropyltryptamine "N,N-Dipropyltryptamine") Tooltip N,N-Dipropyltryptamine [Ibogaine](https://en.wikipedia.org/wiki/Ibogaine "Ibogaine") [Imipramine](https://en.wikipedia.org/wiki/Imipramine "Imipramine") [KCR-12-83.1](https://en.wikipedia.org/w/index.php?title=KCR-12-83.1&action=edit&redlink=1 "KCR-12-83.1 (page does not exist)") [Nemonapride](https://en.wikipedia.org/wiki/Nemonapride "Nemonapride") [Noribogaine](https://en.wikipedia.org/wiki/Noribogaine "Noribogaine") [RHL-033](https://en.wikipedia.org/w/index.php?title=RHL-033&action=edit&redlink=1 "RHL-033 (page does not exist)") [RS-67,333](https://en.wikipedia.org/wiki/RS-67,333 "RS-67,333") [RTI-55](https://en.wikipedia.org/wiki/RTI-55 "RTI-55") [Saffron](https://en.wikipedia.org/wiki/Saffron "Saffron") [Safinamide](https://en.wikipedia.org/wiki/Safinamide "Safinamide") [Selegiline](https://en.wikipedia.org/wiki/Selegiline "Selegiline") [Spipethiane](https://en.wikipedia.org/w/index.php?title=Spipethiane&action=edit&redlink=1 "Spipethiane (page does not exist)") [Trifluoperazine](https://en.wikipedia.org/wiki/Trifluoperazine "Trifluoperazine") [W-18](https://en.wikipedia.org/wiki/W-18_\(drug\) "W-18 (drug)") [YKP10A](https://en.wikipedia.org/wiki/YKP10A "YKP10A") | | [σ2](https://en.wikipedia.org/wiki/Sigma-2_receptor "Sigma-2 receptor") | **Agonists:** [3-PPP](https://en.wikipedia.org/wiki/3-PPP "3-PPP") [Arketamine](https://en.wikipedia.org/wiki/Arketamine "Arketamine") [BD-1047](https://en.wikipedia.org/wiki/BD-1047 "BD-1047") [BD1063](https://en.wikipedia.org/wiki/BD1063 "BD1063") [Ditolylguanidine (DTG)](https://en.wikipedia.org/wiki/Ditolylguanidine "Ditolylguanidine") [DKR-1005](https://en.wikipedia.org/w/index.php?title=DKR-1005&action=edit&redlink=1 "DKR-1005 (page does not exist)") [DKR-1051](https://en.wikipedia.org/w/index.php?title=DKR-1051&action=edit&redlink=1 "DKR-1051 (page does not exist)") [Haloperidol](https://en.wikipedia.org/wiki/Haloperidol "Haloperidol") [Ifenprodil](https://en.wikipedia.org/wiki/Ifenprodil "Ifenprodil") [Ketamine](https://en.wikipedia.org/wiki/Ketamine "Ketamine") [MDMA (midomafetamine)](https://en.wikipedia.org/wiki/MDMA "MDMA") [Methamphetamine](https://en.wikipedia.org/wiki/Methamphetamine "Methamphetamine") [OPC-14523](https://en.wikipedia.org/w/index.php?title=OPC-14523&action=edit&redlink=1 "OPC-14523 (page does not exist)") [Opipramol](https://en.wikipedia.org/wiki/Opipramol "Opipramol") [PB-28](https://en.wikipedia.org/wiki/PB-28 "PB-28") [Phencyclidine](https://en.wikipedia.org/wiki/Phencyclidine "Phencyclidine") [Siramesine (Lu 28-179)](https://en.wikipedia.org/wiki/Siramesine "Siramesine") [UKH-1114](https://en.wikipedia.org/w/index.php?title=UKH-1114&action=edit&redlink=1 "UKH-1114 (page does not exist)") **Antagonists:** [AC-927](https://en.wikipedia.org/wiki/AC-927 "AC-927") [BD-1008](https://en.wikipedia.org/wiki/BD-1008 "BD-1008") [BD-1067](https://en.wikipedia.org/wiki/BD-1067 "BD-1067") [CM-156](https://en.wikipedia.org/wiki/CM-156 "CM-156") [LR-172](https://en.wikipedia.org/w/index.php?title=LR-172&action=edit&redlink=1 "LR-172 (page does not exist)") [MIN-101](https://en.wikipedia.org/wiki/MIN-101 "MIN-101") [Panamesine (EMD-57455)](https://en.wikipedia.org/wiki/Panamesine "Panamesine") [SAS-0132](https://en.wikipedia.org/w/index.php?title=SAS-0132&action=edit&redlink=1 "SAS-0132 (page does not exist)") [Zervimesine (CT-1812)](https://en.wikipedia.org/wiki/Zervimesine "Zervimesine") **Unknown/unsorted:** [3-Methoxydextrallorphan](https://en.wikipedia.org/w/index.php?title=3-Methoxydextrallorphan&action=edit&redlink=1 "3-Methoxydextrallorphan (page does not exist)") [3-MeO-PCE](https://en.wikipedia.org/wiki/3-MeO-PCE "3-MeO-PCE") [4-MeO-PCP](https://en.wikipedia.org/wiki/4-MeO-PCP "4-MeO-PCP") [5-MeO-DALT](https://en.wikipedia.org/wiki/5-MeO-DALT "5-MeO-DALT") [5-MeO-DiPT](https://en.wikipedia.org/wiki/5-MeO-DiPT "5-MeO-DiPT") [Clemastine](https://en.wikipedia.org/wiki/Clemastine "Clemastine") [DiPT](https://en.wikipedia.org/wiki/N,N-Diisopropyltryptamine "N,N-Diisopropyltryptamine") Tooltip N,N-Diisopropyltryptamine [DPT](https://en.wikipedia.org/wiki/N,N-Dipropyltryptamine "N,N-Dipropyltryptamine") Tooltip N,N-Dipropyltryptamine [Ibogaine](https://en.wikipedia.org/wiki/Ibogaine "Ibogaine") [Lu 29-252](https://en.wikipedia.org/wiki/Lu_29-252 "Lu 29-252") [Nemonapride](https://en.wikipedia.org/wiki/Nemonapride "Nemonapride") [Nepinalone](https://en.wikipedia.org/wiki/Nepinalone "Nepinalone") [Noribogaine](https://en.wikipedia.org/wiki/Noribogaine "Noribogaine") [Pentazocine](https://en.wikipedia.org/wiki/Pentazocine "Pentazocine") [RS-67,333](https://en.wikipedia.org/wiki/RS-67,333 "RS-67,333") [Safinamide](https://en.wikipedia.org/wiki/Safinamide "Safinamide") [TMA](https://en.wikipedia.org/wiki/3,4,5-Trimethoxyamphetamine "3,4,5-Trimethoxyamphetamine") Tooltip 3,4,5-Trimethoxyamphetamine [UMB-23](https://en.wikipedia.org/w/index.php?title=UMB-23&action=edit&redlink=1 "UMB-23 (page does not exist)") [UMB-82](https://en.wikipedia.org/w/index.php?title=UMB-82&action=edit&redlink=1 "UMB-82 (page does not exist)") [W-18](https://en.wikipedia.org/wiki/W-18_\(drug\) "W-18 (drug)") | | Unsorted | **Agonists:** [Berberine](https://en.wikipedia.org/wiki/Berberine "Berberine") [Ethylketazocine](https://en.wikipedia.org/wiki/Ethylketazocine "Ethylketazocine") [Fourphit](https://en.wikipedia.org/wiki/Fourphit "Fourphit") [Metaphit](https://en.wikipedia.org/wiki/Metaphit "Metaphit") [Naluzotan](https://en.wikipedia.org/wiki/Naluzotan "Naluzotan") [Tapentadol](https://en.wikipedia.org/wiki/Tapentadol "Tapentadol") [Tenocyclidine](https://en.wikipedia.org/wiki/Tenocyclidine "Tenocyclidine") **Antagonists:** [AHD1](https://en.wikipedia.org/w/index.php?title=AHD1&action=edit&redlink=1 "AHD1 (page does not exist)") [AZ66](https://en.wikipedia.org/w/index.php?title=AZ66&action=edit&redlink=1 "AZ66 (page does not exist)") [Lamotrigine](https://en.wikipedia.org/wiki/Lamotrigine "Lamotrigine") [Naloxone](https://en.wikipedia.org/wiki/Naloxone "Naloxone") [SM-21](https://en.wikipedia.org/w/index.php?title=SM-21&action=edit&redlink=1 "SM-21 (page does not exist)") [UMB-100](https://en.wikipedia.org/w/index.php?title=UMB-100&action=edit&redlink=1 "UMB-100 (page does not exist)") [UMB-101](https://en.wikipedia.org/w/index.php?title=UMB-101&action=edit&redlink=1 "UMB-101 (page does not exist)") [UMB-103](https://en.wikipedia.org/w/index.php?title=UMB-103&action=edit&redlink=1 "UMB-103 (page does not exist)") [UMB-116](https://en.wikipedia.org/w/index.php?title=UMB-116&action=edit&redlink=1 "UMB-116 (page does not exist)") [YZ-011](https://en.wikipedia.org/w/index.php?title=YZ-011&action=edit&redlink=1 "YZ-011 (page does not exist)") [YZ-069](https://en.wikipedia.org/w/index.php?title=YZ-069&action=edit&redlink=1 "YZ-069 (page does not exist)") [YZ-185](https://en.wikipedia.org/w/index.php?title=YZ-185&action=edit&redlink=1 "YZ-185 (page does not exist)") **Allosteric modulators:** [SKF-83959](https://en.wikipedia.org/wiki/SKF-83959 "SKF-83959") **Unknown/unsorted:** [18-Methoxycoronaridine](https://en.wikipedia.org/wiki/18-Methoxycoronaridine "18-Methoxycoronaridine") [BMY-13980](https://en.wikipedia.org/w/index.php?title=BMY-13980&action=edit&redlink=1 "BMY-13980 (page does not exist)") [Butaclamol](https://en.wikipedia.org/wiki/Butaclamol "Butaclamol") [Caramiphen](https://en.wikipedia.org/wiki/Caramiphen "Caramiphen") [Carvotroline](https://en.wikipedia.org/w/index.php?title=Carvotroline&action=edit&redlink=1 "Carvotroline (page does not exist)") [Chlorphenamine (chlorpheniramine)](https://en.wikipedia.org/wiki/Chlorphenamine "Chlorphenamine") [Chlorpromazine](https://en.wikipedia.org/wiki/Chlorpromazine "Chlorpromazine") [Cinnarizine](https://en.wikipedia.org/wiki/Cinnarizine "Cinnarizine") [Cinuperone](https://en.wikipedia.org/w/index.php?title=Cinuperone&action=edit&redlink=1 "Cinuperone (page does not exist)") [Clocapramine](https://en.wikipedia.org/wiki/Clocapramine "Clocapramine") [Dezocine](https://en.wikipedia.org/wiki/Dezocine "Dezocine") [EMD-59983](https://en.wikipedia.org/w/index.php?title=EMD-59983&action=edit&redlink=1 "EMD-59983 (page does not exist)") [Hypericin](https://en.wikipedia.org/wiki/Hypericin "Hypericin") ([St. John's wort](https://en.wikipedia.org/wiki/St._John%27s_wort "St. John's wort")) [Fluphenazine](https://en.wikipedia.org/wiki/Fluphenazine "Fluphenazine") [Gevotroline (WY-47384)](https://en.wikipedia.org/wiki/Gevotroline "Gevotroline") [Mepyramine (pyrilamine)](https://en.wikipedia.org/wiki/Mepyramine "Mepyramine") [Molindone](https://en.wikipedia.org/wiki/Molindone "Molindone") [Perphenazine](https://en.wikipedia.org/wiki/Perphenazine "Perphenazine") [Pimozide](https://en.wikipedia.org/wiki/Pimozide "Pimozide") [Proadifen](https://en.wikipedia.org/wiki/Proadifen "Proadifen") [Promethazine](https://en.wikipedia.org/wiki/Promethazine "Promethazine") [Propranolol](https://en.wikipedia.org/wiki/Propranolol "Propranolol") [Quinidine](https://en.wikipedia.org/wiki/Quinidine "Quinidine") [Remoxipride](https://en.wikipedia.org/wiki/Remoxipride "Remoxipride") [SL 82.0715](https://en.wikipedia.org/w/index.php?title=SL_82.0715&action=edit&redlink=1 "SL 82.0715 (page does not exist)") [SR-31747A](https://en.wikipedia.org/w/index.php?title=SR-31747A&action=edit&redlink=1 "SR-31747A (page does not exist)") [Tiospirone (BMY-13859)](https://en.wikipedia.org/wiki/Tiospirone "Tiospirone") [Venlafaxine](https://en.wikipedia.org/wiki/Venlafaxine "Venlafaxine") | | ***See also:** [Receptor/signaling modulators](https://en.wikipedia.org/wiki/Template:Receptor_modulators "Template:Receptor modulators")* | | [Portal](https://en.wikipedia.org/wiki/Wikipedia:Contents/Portals "Wikipedia:Contents/Portals"): - ![icon](https://upload.wikimedia.org/wikipedia/commons/thumb/d/d6/WHO_Rod.svg/20px-WHO_Rod.svg.png) [Medicine](https://en.wikipedia.org/wiki/Portal:Medicine "Portal:Medicine") | [Authority control databases](https://en.wikipedia.org/wiki/Help:Authority_control "Help:Authority control") [![Edit this at Wikidata](https://upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png)](https://www.wikidata.org/wiki/Q407617#identifiers "Edit this at Wikidata") | | |---|---| | National | [United States](https://id.loc.gov/authorities/sh93006171) [Israel](https://www.nli.org.il/en/authorities/987007537058005171) | | Other | [Yale LUX](https://lux.collections.yale.edu/view/concept/a699ec30-4b61-429a-b3f7-5c58c37c9b2d) | ![](https://en.wikipedia.org/wiki/Special:CentralAutoLogin/start?useformat=desktop&type=1x1&usesul3=1) Retrieved from "<https://en.wikipedia.org/w/index.php?title=Sertraline&oldid=1347773962>" [Categories](https://en.wikipedia.org/wiki/Help:Category "Help:Category"): - [1-Aminotetralins](https://en.wikipedia.org/wiki/Category:1-Aminotetralins "Category:1-Aminotetralins") - [Secondary amines](https://en.wikipedia.org/wiki/Category:Secondary_amines "Category:Secondary amines") - [Antidepressants](https://en.wikipedia.org/wiki/Category:Antidepressants "Category:Antidepressants") - [Chlorobenzene derivatives](https://en.wikipedia.org/wiki/Category:Chlorobenzene_derivatives "Category:Chlorobenzene derivatives") - [CYP2B6 inhibitors](https://en.wikipedia.org/wiki/Category:CYP2B6_inhibitors "Category:CYP2B6 inhibitors") - [CYP2C9 inhibitors](https://en.wikipedia.org/wiki/Category:CYP2C9_inhibitors "Category:CYP2C9 inhibitors") - [CYP2D6 inhibitors](https://en.wikipedia.org/wiki/Category:CYP2D6_inhibitors "Category:CYP2D6 inhibitors") - [Dopamine reuptake inhibitors](https://en.wikipedia.org/wiki/Category:Dopamine_reuptake_inhibitors "Category:Dopamine reuptake inhibitors") - [Drugs developed by Pfizer](https://en.wikipedia.org/wiki/Category:Drugs_developed_by_Pfizer "Category:Drugs developed by Pfizer") - [MTOR 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| | | |---|---| | [![](https://upload.wikimedia.org/wikipedia/commons/thumb/b/b4/Sertraline.svg/250px-Sertraline.svg.png)](https://en.wikipedia.org/wiki/File:Sertraline.svg) | | | [![](https://upload.wikimedia.org/wikipedia/commons/thumb/6/61/Sertraline-A-3D-balls.png/250px-Sertraline-A-3D-balls.png)](https://en.wikipedia.org/wiki/File:Sertraline-A-3D-balls.png) | | | Clinical data | | | Pronunciation | [ⓘ](https://en.wikipedia.org/wiki/File:LL-Q1860_\(eng\)-Naomi_Persephone_Amethyst_\(NaomiAmethyst\)-sertraline.wav "File:LL-Q1860 (eng)-Naomi Persephone Amethyst (NaomiAmethyst)-sertraline.wav") [*SUR\-trə-leen*](https://en.wikipedia.org/wiki/Help:Pronunciation_respelling_key "Help:Pronunciation respelling key") | | [Trade names](https://en.wikipedia.org/wiki/Drug_nomenclature#Trade_names "Drug nomenclature") | Zoloft, Lustral, Setrona, others[\[1\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Brand2015-1) | | [AHFS](https://en.wikipedia.org/wiki/American_Society_of_Health-System_Pharmacists "American Society of Health-System Pharmacists")/[Drugs.com](https://en.wikipedia.org/wiki/Drugs.com "Drugs.com") | [Monograph](https://www.drugs.com/monograph/sertraline-hydrochloride.html) | | [MedlinePlus](https://en.wikipedia.org/wiki/MedlinePlus "MedlinePlus") | [a697048](https://medlineplus.gov/druginfo/meds/a697048.html) | | [License data](https://en.wikipedia.org/wiki/Regulation_of_therapeutic_goods "Regulation of therapeutic goods") | US [DailyMed](https://en.wikipedia.org/wiki/DailyMed "DailyMed"): [Sertraline](https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=Sertraline) | | [Pregnancy category](https://en.wikipedia.org/wiki/Pregnancy_category "Pregnancy category") | AU : C[\[2\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Drugs.com_pregnancy-2) | | [Addiction liability](https://en.wikipedia.org/wiki/Addiction "Addiction") | None[\[3\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Hub2001-3) | | [Routes of administration](https://en.wikipedia.org/wiki/Route_of_administration "Route of administration") | [By mouth](https://en.wikipedia.org/wiki/Oral_administration "Oral administration") | | [Drug class](https://en.wikipedia.org/wiki/Drug_class "Drug class") | [Selective serotonin reuptake inhibitor](https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor "Selective serotonin reuptake inhibitor") (SSRI) | | [ATC code](https://en.wikipedia.org/wiki/Anatomical_Therapeutic_Chemical_Classification_System "Anatomical Therapeutic Chemical Classification System") | [N06AB06](https://en.wikipedia.org/wiki/ATC_code_N06 "ATC code N06") ([WHO](https://www.whocc.no/atc_ddd_index/?code=N06AB06)) | | Legal status | | | [Legal status](https://en.wikipedia.org/wiki/Regulation_of_therapeutic_goods "Regulation of therapeutic goods") | AU : [S4](https://en.wikipedia.org/wiki/Standard_for_the_Uniform_Scheduling_of_Medicines_and_Poisons#Schedule_4 "Standard for the Uniform Scheduling of Medicines and Poisons") (Prescription only) BR : [Class C1](https://en.wikipedia.org/wiki/Brazilian_Controlled_Drugs_and_Substances_Act#Class_C1 "Brazilian Controlled Drugs and Substances Act") (Other controlled substances)[\[4\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-4) CA : [℞-only](https://en.wikipedia.org/wiki/Prescription_drug "Prescription drug") NZ : Prescription only UK : [POM](https://en.wikipedia.org/wiki/Prescription_drug "Prescription drug") (Prescription only) US : [℞-only](https://en.wikipedia.org/wiki/Prescription_drug "Prescription drug") In general: ℞ (Prescription only) | | [Pharmacokinetic](https://en.wikipedia.org/wiki/Pharmacokinetics "Pharmacokinetics") data | | | [Bioavailability](https://en.wikipedia.org/wiki/Bioavailability "Bioavailability") | 44%\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\] | | [Protein binding](https://en.wikipedia.org/wiki/Plasma_protein_binding "Plasma protein binding") | 98\.5%\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\] | | [Metabolism](https://en.wikipedia.org/wiki/Drug_metabolism "Drug metabolism") | [Liver](https://en.wikipedia.org/wiki/Liver "Liver") (primarily *N*\-[demethylation](https://en.wikipedia.org/wiki/Demethylation "Demethylation") mainly by [CYP2B6](https://en.wikipedia.org/wiki/CYP2B6 "CYP2B6"); also metabolism by [CYP2C19](https://en.wikipedia.org/wiki/CYP2C19 "CYP2C19"), others)[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5)[\[9\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid15547048-9) | | [Metabolites](https://en.wikipedia.org/wiki/Metabolite "Metabolite") | ‱ [Desmethylsertraline](https://en.wikipedia.org/wiki/Desmethylsertraline "Desmethylsertraline") ‱ Others (e.g., [hydroxylated](https://en.wikipedia.org/wiki/Hydroxylation "Hydroxylation") [metabolites](https://en.wikipedia.org/wiki/Metabolite "Metabolite"), [glucuronide](https://en.wikipedia.org/wiki/Glucuronide "Glucuronide") [conjugates](https://en.wikipedia.org/wiki/Conjugation_\(biochemistry\) "Conjugation (biochemistry)"))[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) | | [Elimination half-life](https://en.wikipedia.org/wiki/Biological_half-life "Biological half-life") | ‱ Sertraline: 26 hours (32 hours in females, 22 hours in males; range 13–45 hours)[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5)[\[6\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-GG-6)[\[7\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16192315-7)[\[8\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12452737-8) ‱ Desmethylsertraline: 62–104 hours[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) | | [Excretion](https://en.wikipedia.org/wiki/Excretion "Excretion") | [Urine](https://en.wikipedia.org/wiki/Urine "Urine") (40–45%)[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) [Feces](https://en.wikipedia.org/wiki/Feces "Feces") (40–45%)[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) | | Identifiers | | | [IUPAC name](https://en.wikipedia.org/wiki/IUPAC_nomenclature_of_chemistry "IUPAC nomenclature of chemistry") (1*S*,4*S*)-4-(3,4-Dichlorophenyl)-*N*\-methyl-1,2,3,4-tetrahydronaphthalen-1-amine | | | [CAS Number](https://en.wikipedia.org/wiki/CAS_Registry_Number "CAS Registry Number") | [79617-96-2](https://commonchemistry.cas.org/detail?cas_rn=79617-96-2) ![check](https://upload.wikimedia.org/wikipedia/en/thumb/f/fb/Yes_check.svg/20px-Yes_check.svg.png) | | [PubChem](https://en.wikipedia.org/wiki/PubChem#CID "PubChem") CID | [68617](https://pubchem.ncbi.nlm.nih.gov/compound/68617) | | [IUPHAR/BPS](https://en.wikipedia.org/wiki/Guide_to_Pharmacology "Guide to Pharmacology") | [4798](https://www.guidetopharmacology.org/GRAC/LigandDisplayForward?ligandId=4798) | | [DrugBank](https://en.wikipedia.org/wiki/DrugBank "DrugBank") | [DB01104](https://www.drugbank.ca/drugs/DB01104) ![check](https://upload.wikimedia.org/wikipedia/en/thumb/f/fb/Yes_check.svg/20px-Yes_check.svg.png) | | [ChemSpider](https://en.wikipedia.org/wiki/ChemSpider "ChemSpider") | [61881](https://www.chemspider.com/Chemical-Structure.61881.html) ![check](https://upload.wikimedia.org/wikipedia/en/thumb/f/fb/Yes_check.svg/20px-Yes_check.svg.png) | | [UNII](https://en.wikipedia.org/wiki/Unique_Ingredient_Identifier "Unique Ingredient Identifier") | [QUC7NX6WMB](https://precision.fda.gov/uniisearch/srs/unii/QUC7NX6WMB) | | [KEGG](https://en.wikipedia.org/wiki/KEGG "KEGG") | [D02360](https://www.kegg.jp/entry/D02360) ![check](https://upload.wikimedia.org/wikipedia/en/thumb/f/fb/Yes_check.svg/20px-Yes_check.svg.png) as HCl: [D00825](https://www.kegg.jp/entry/D00825) ![check](https://upload.wikimedia.org/wikipedia/en/thumb/f/fb/Yes_check.svg/20px-Yes_check.svg.png) | | [ChEBI](https://en.wikipedia.org/wiki/ChEBI "ChEBI") | [CHEBI:9123](https://www.ebi.ac.uk/chebi/searchId.do?chebiId=CHEBI:9123) ![check](https://upload.wikimedia.org/wikipedia/en/thumb/f/fb/Yes_check.svg/20px-Yes_check.svg.png) | | [ChEMBL](https://en.wikipedia.org/wiki/ChEMBL "ChEMBL") | [ChEMBL809](https://www.ebi.ac.uk/chembl/explore/compound/ChEMBL809) ![check](https://upload.wikimedia.org/wikipedia/en/thumb/f/fb/Yes_check.svg/20px-Yes_check.svg.png) | | [CompTox Dashboard](https://en.wikipedia.org/wiki/CompTox_Chemicals_Dashboard "CompTox Chemicals Dashboard") ( EPA ) | [DTXSID6023577](https://comptox.epa.gov/dashboard/chemical/details/DTXSID6023577) [![Edit this at Wikidata](https://upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png)](https://www.wikidata.org/wiki/Q407617#P3117 "Edit this at Wikidata") | | Chemical and physical data | | | [Formula](https://en.wikipedia.org/wiki/Chemical_formula "Chemical formula") | C17H17Cl2N | | [Molar mass](https://en.wikipedia.org/wiki/Molar_mass "Molar mass") | 306\.23 g·mol−1 | | 3D model ([JSmol](https://en.wikipedia.org/wiki/JSmol "JSmol")) | [Interactive image](https://chemapps.stolaf.edu/jmol/jmol.php?model=ClC1%3DCC%3DC%28%5BC%40H%5D2C3%3DC%28%5BC%40H%5D%28CC2%29NC%29C%3DCC%3DC3%29C%3DC1Cl) | | [SMILES](https://en.wikipedia.org/wiki/Simplified_molecular-input_line-entry_system "Simplified molecular-input line-entry system") ClC1=CC=C(\[C@H\]2C3=C(\[C@H\](CC2)NC)C=CC=C3)C=C1Cl | | | [InChI](https://en.wikipedia.org/wiki/International_Chemical_Identifier "International Chemical Identifier") InChI=1S/C17H17NCl2/c1-20-17-9-7-12(13-4-2-3-5-14(13)17)11-6-8-15(18)16(19)10-11/h2-6,8,10,12,17,20H,7,9H2,1H3/t12-,17-/m0/s1 ![check](https://upload.wikimedia.org/wikipedia/en/thumb/f/fb/Yes_check.svg/20px-Yes_check.svg.png) Key:VGKDLMBJGBXTGI-SJCJKPOMSA-N ![check](https://upload.wikimedia.org/wikipedia/en/thumb/f/fb/Yes_check.svg/20px-Yes_check.svg.png) | | | [(verify)](https://en.wikipedia.org/w/index.php?title=Special:ComparePages&rev1=464389436&page2=Sertraline) | | **Sertraline**, sold under the brand name **Zoloft** among others, is an [antidepressant medication](https://en.wikipedia.org/wiki/Antidepressant "Antidepressant") of the [selective serotonin reuptake inhibitor](https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor "Selective serotonin reuptake inhibitor") (SSRI) class[\[10\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-AHFS2018-10) used to treat [major depressive disorder](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder"), [generalized anxiety disorder](https://en.wikipedia.org/wiki/Generalized_anxiety_disorder "Generalized anxiety disorder"), [social anxiety disorder](https://en.wikipedia.org/wiki/Social_anxiety_disorder "Social anxiety disorder"), [obsessive–compulsive disorder](https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_disorder "Obsessive–compulsive disorder") (OCD), [panic disorder](https://en.wikipedia.org/wiki/Panic_disorder "Panic disorder"), and [premenstrual dysphoric disorder](https://en.wikipedia.org/wiki/Premenstrual_dysphoric_disorder "Premenstrual dysphoric disorder").[\[11\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-11) Although also having approval for [post-traumatic stress disorder](https://en.wikipedia.org/wiki/Post-traumatic_stress_disorder "Post-traumatic stress disorder") (PTSD), findings indicate it leads to only modest improvements in symptoms associated with this condition.[\[12\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid25644881-12)[\[13\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid27126398-13) The drug shares the common [side effects](https://en.wikipedia.org/wiki/Side_effect "Side effect") and [contraindications](https://en.wikipedia.org/wiki/Contraindication "Contraindication") of other SSRIs, with high rates of [nausea](https://en.wikipedia.org/wiki/Nausea "Nausea"), [diarrhea](https://en.wikipedia.org/wiki/Diarrhea "Diarrhea"), [headache](https://en.wikipedia.org/wiki/Headache "Headache"), [insomnia](https://en.wikipedia.org/wiki/Insomnia "Insomnia"), mild [sedation](https://en.wikipedia.org/wiki/Somnolence "Somnolence"), [dry mouth](https://en.wikipedia.org/wiki/Dry_mouth "Dry mouth"), and [sexual dysfunction](https://en.wikipedia.org/wiki/Sexual_dysfunction "Sexual dysfunction"), but it appears not to lead to much [weight gain](https://en.wikipedia.org/wiki/Weight_gain "Weight gain"), and its effects on [cognitive performance](https://en.wikipedia.org/wiki/Cognition "Cognition") are mild. In some patients, sexual dysfunction may persist even after the drug is discontinued, a condition known as [post-SSRI sexual dysfunction](https://en.wikipedia.org/wiki/Post-SSRI_sexual_dysfunction "Post-SSRI sexual dysfunction"); regulatory agencies including the [European Medicines Agency](https://en.wikipedia.org/wiki/European_Medicines_Agency "European Medicines Agency") and [Health Canada](https://en.wikipedia.org/wiki/Health_Canada "Health Canada") have recommended that sertraline's product labeling warn of this risk.[\[14\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Healy2022-14)[\[15\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-PRAC2019-15) Similar to other antidepressants, the use of sertraline for depression may be associated with a mildly elevated rate of [suicidal thoughts](https://en.wikipedia.org/wiki/Suicidal_thoughts "Suicidal thoughts") in people under the age of 25 years old. It should not be used together with [monoamine oxidase inhibitors](https://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor "Monoamine oxidase inhibitor") (MAOIs): this combination may cause [serotonin syndrome](https://en.wikipedia.org/wiki/Serotonin_syndrome "Serotonin syndrome"), which can be life-threatening in some cases. Sertraline taken during pregnancy is associated with an increase in [congenital heart defects](https://en.wikipedia.org/wiki/Congenital_heart_defect "Congenital heart defect") in newborns.[\[16\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid30415641-16)[\[17\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid33354752-17) Sertraline was developed by scientists at [Pfizer](https://en.wikipedia.org/wiki/Pfizer "Pfizer") and approved for medical use in the United States in 1991. It is on the [World Health Organization's List of Essential Medicines](https://en.wikipedia.org/wiki/WHO_Model_List_of_Essential_Medicines "WHO Model List of Essential Medicines")[\[18\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-WHO23rd-18) and available as a [generic medication](https://en.wikipedia.org/wiki/Generic_medication "Generic medication").[\[10\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-AHFS2018-10) In 2016, sertraline was the most commonly prescribed psychotropic medication in the United States.[\[19\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-PsychCentral2-19) It was also the eleventh most commonly prescribed medication in the United States, with more than 42 million prescriptions in 2023,[\[20\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Top300Drugs-20)[\[21\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-21) and sertraline ranks among the top 10 most prescribed medications in Australia between 2017 and 2023.[\[22\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-22) Sertraline's [effectiveness](https://en.wikipedia.org/wiki/Effectiveness "Effectiveness") is similar to that of other antidepressants in its class, such as [fluoxetine](https://en.wikipedia.org/wiki/Fluoxetine "Fluoxetine") and [paroxetine](https://en.wikipedia.org/wiki/Paroxetine "Paroxetine"), which are also considered first-line treatments and are better tolerated than the older [tricyclic antidepressants](https://en.wikipedia.org/wiki/Tricyclic_antidepressants "Tricyclic antidepressants"). Sertraline has been approved for [major depressive disorder](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder"), [obsessive–compulsive disorder](https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_disorder "Obsessive–compulsive disorder") (OCD), [post-traumatic stress disorder](https://en.wikipedia.org/wiki/Post-traumatic_stress_disorder "Post-traumatic stress disorder") (PTSD), [premenstrual dysphoric disorder](https://en.wikipedia.org/wiki/Premenstrual_dysphoric_disorder "Premenstrual dysphoric disorder"), [panic disorder](https://en.wikipedia.org/wiki/Panic_disorder "Panic disorder"), [social anxiety disorder](https://en.wikipedia.org/wiki/Social_anxiety_disorder "Social anxiety disorder") (SAD), and [generalized anxiety disorder](https://en.wikipedia.org/wiki/Generalized_anxiety_disorder "Generalized anxiety disorder") (GAD). Sertraline is approved for use in children with OCD.[\[23\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-DailyMed-23) In [meta-analyses](https://en.wikipedia.org/wiki/Meta-analysis "Meta-analysis"), sertraline efficacy is similar to that of other SSRI antidepressants, with an [odds ratio](https://en.wikipedia.org/wiki/Odds_ratio "Odds ratio") for response in clinical depression of between 1.44 and 1.67.[\[24\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Jakobsen2017-24)[\[25\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-CiprianiFurukawa2018-25) However, as with other antidepressants, the nature and clinical significance of this effect remain disputed.[\[26\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Moncrieff2018-26)[\[27\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-BMJ2019-27) A major study of sertraline in a broad primary care population found improvements in general mental health, quality of life, and anxiety.[\[28\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Lewis2019-28) However, it failed to find significant effects on depression in either the mildly or severely depressed, and the clinical relevance and accuracy of the positive effects found have been questioned.[\[29\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Hengartner2020-29)[\[30\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Paludan202020-30) In several [double-blind](https://en.wikipedia.org/wiki/Double-blind "Double-blind") studies, sertraline was consistently more effective than [placebo](https://en.wikipedia.org/wiki/Placebo "Placebo") for [dysthymia](https://en.wikipedia.org/wiki/Dysthymia "Dysthymia"), a more chronic variety of depression, and comparable to [imipramine](https://en.wikipedia.org/wiki/Imipramine "Imipramine") in that respect. Sertraline also improves the functional impairments of dysthymia to a similar degree whether group Cognitive-Behavioral Therapy is undergone or not.[\[31\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid21456103-31) Limited pediatric data also demonstrates a reduction in depressive symptoms in the pediatric population though remains a second-line therapy after fluoxetine.[\[32\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-32)[\[33\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-33) #### Comparison with other antidepressants \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=3 "Edit section: Comparison with other antidepressants")\] In general, sertraline efficacy is similar to that of other antidepressants.[\[34\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11420570-34) For example, a meta-analysis of 12 new-generation antidepressants showed that sertraline and [escitalopram](https://en.wikipedia.org/wiki/Escitalopram "Escitalopram") are the best in terms of efficacy and acceptability in the acute-phase treatment of adults with depression.[\[35\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-cipriani-35) Comparative clinical trials demonstrated that sertraline is similar in efficacy against depression to [moclobemide](https://en.wikipedia.org/wiki/Moclobemide "Moclobemide"),[\[36\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid17168253-36) [nefazodone](https://en.wikipedia.org/wiki/Nefazodone "Nefazodone"),[\[37\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid8626364-37) [escitalopram](https://en.wikipedia.org/wiki/Escitalopram "Escitalopram"), [bupropion](https://en.wikipedia.org/wiki/Bupropion "Bupropion"),[\[38\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9448656-38) [citalopram](https://en.wikipedia.org/wiki/Citalopram "Citalopram"), [fluvoxamine](https://en.wikipedia.org/wiki/Fluvoxamine "Fluvoxamine"), [paroxetine](https://en.wikipedia.org/wiki/Paroxetine "Paroxetine"),[\[35\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-cipriani-35) [venlafaxine](https://en.wikipedia.org/wiki/Venlafaxine "Venlafaxine"),[\[39\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16870212-39) and [mirtazapine](https://en.wikipedia.org/wiki/Mirtazapine "Mirtazapine").[\[40\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16172440-40) Sertraline may be more efficacious for the treatment of depression in the acute phase (first four weeks) than [fluoxetine](https://en.wikipedia.org/wiki/Fluoxetine "Fluoxetine").[\[41\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-41) There are differences between sertraline and some other antidepressants in their efficacy in the treatment of different subtypes of depression and in their adverse effects. For severe depression, sertraline is as good as [clomipramine](https://en.wikipedia.org/wiki/Clomipramine "Clomipramine") but is better tolerated.[\[39\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16870212-39) Sertraline appears to work better in [melancholic depression](https://en.wikipedia.org/wiki/Melancholic_depression "Melancholic depression") than fluoxetine, [paroxetine](https://en.wikipedia.org/wiki/Paroxetine "Paroxetine"), and [mianserin](https://en.wikipedia.org/wiki/Mianserin "Mianserin") and is similar to the [tricyclic antidepressants](https://en.wikipedia.org/wiki/Tricyclic_antidepressants "Tricyclic antidepressants") such as [amitriptyline](https://en.wikipedia.org/wiki/Amitriptyline "Amitriptyline") and [clomipramine](https://en.wikipedia.org/wiki/Clomipramine "Clomipramine").[\[34\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11420570-34) In the treatment of depression accompanied by [OCD](https://en.wikipedia.org/wiki/OCD "OCD"), sertraline performs significantly better than [desipramine](https://en.wikipedia.org/wiki/Desipramine "Desipramine") on the measures of both OCD and depression.[\[31\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid21456103-31)[\[42\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid25969470-42) Sertraline is equivalent to imipramine for the treatment of depression with co-morbid panic disorder, but it is better tolerated.[\[43\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12516310-43) Compared with amitriptyline, sertraline offered a greater overall improvement in [quality of life](https://en.wikipedia.org/wiki/Quality_of_life "Quality of life") of depressed patients.[\[34\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11420570-34) #### Depression in elderly \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=4 "Edit section: Depression in elderly")\] Sertraline used for the treatment of depression in elderly (older than 60) patients is superior to placebo and comparable to another SSRI fluoxetine, and [tricyclic antidepressants](https://en.wikipedia.org/wiki/Tricyclic_antidepressants "Tricyclic antidepressants") (TCAs) amitriptyline, [nortriptyline](https://en.wikipedia.org/wiki/Nortriptyline "Nortriptyline") and [imipramine](https://en.wikipedia.org/wiki/Imipramine "Imipramine"). Sertraline has much lower rates of adverse effects than these TCAs, with the exception of nausea, which occurs more frequently with sertraline. In addition, sertraline appears to be more effective than fluoxetine or nortriptyline in the older-than-70 subgroup.[\[44\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12093324-44) Accordingly, a meta-analysis of antidepressants in older adults found that sertraline, [paroxetine](https://en.wikipedia.org/wiki/Paroxetine "Paroxetine") and [duloxetine](https://en.wikipedia.org/wiki/Duloxetine "Duloxetine") were better than placebo.[\[45\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-45) However, in a 2003 trial the [effect size](https://en.wikipedia.org/wiki/Effect_size "Effect size") was modest, and there was no improvement in [quality of life](https://en.wikipedia.org/wiki/Quality_of_life "Quality of life") as compared to [placebo](https://en.wikipedia.org/wiki/Placebo "Placebo").[\[46\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12832242-46) With depression in dementia, there is no benefit of sertraline treatment compared to either placebo or [mirtazapine](https://en.wikipedia.org/wiki/Mirtazapine "Mirtazapine").[\[47\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Banerjee2013-47) ### Obsessive–compulsive disorder \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=5 "Edit section: Obsessive–compulsive disorder")\] Sertraline is effective for the treatment of OCD in adults,[\[23\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-DailyMed-23) adolescents and children.[\[48\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-NIHR_Evidence_2022-48)[\[49\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Boaden_2020-49)[\[50\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Correll_2021-50) It was better tolerated and, based on [intention-to-treat analysis](https://en.wikipedia.org/wiki/Intention-to-treat_analysis "Intention-to-treat analysis"), performed better than the gold standard of OCD treatment [clomipramine](https://en.wikipedia.org/wiki/Clomipramine "Clomipramine").[\[51\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9393392-51) Continuing sertraline treatment helps prevent relapses of OCD with long-term data supporting its use for up to 24 months.[\[52\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid25081580-52) The sertraline dosages necessary for the effective treatment of OCD are higher than the usual dosage for depression.[\[53\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-medscape-53) The onset of action is also slower for OCD than for depression. The treatment recommendation is to start treatment with half of the maximal recommended dose for at least two months. After that, the dose can be raised to the maximal recommended in the cases of unsatisfactory response.[\[54\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16838823-54) [Cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy") alone is not more effective than sertraline in adolescents and children; however, a combination of these treatments is effective.[\[50\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Correll_2021-50) Sertraline is superior to placebo for the treatment of [panic disorder](https://en.wikipedia.org/wiki/Panic_disorder "Panic disorder").[\[23\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-DailyMed-23) The response rate was independent of the dose. In addition to decreasing the frequency of panic attacks by about 80% (vs. 45% for placebo) and decreasing general anxiety, sertraline resulted in an improvement in quality of life on most parameters. The patients rated as "improved" on sertraline reported better quality of life than the ones who "improved" on placebo. The authors of the study argued that the improvement achieved with sertraline is different and of a better quality than the improvement achieved with a placebo.[\[55\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid10945134-55)[\[56\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16292466-56) Sertraline is equally effective for men and women,[\[56\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16292466-56) and for patients with or without agoraphobia.[\[57\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11206597-57) Previous unsuccessful treatment with [benzodiazepines](https://en.wikipedia.org/wiki/Benzodiazepines "Benzodiazepines") does not diminish its efficacy.[\[58\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11199932-58) However, the response rate was lower for the patients with more severe panic.[\[57\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11206597-57) Starting treatment simultaneously with sertraline and [clonazepam](https://en.wikipedia.org/wiki/Clonazepam "Clonazepam"), with subsequent gradual discontinuation of clonazepam, may accelerate the response.[\[59\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Amrein-59) Double-blind comparative studies found sertraline to have the same effect on panic disorder as [paroxetine](https://en.wikipedia.org/wiki/Paroxetine "Paroxetine") or [imipramine](https://en.wikipedia.org/wiki/Imipramine "Imipramine").[\[60\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid21342080-60) While imprecise, comparison of the results of trials of sertraline with separate trials of other anti-panic agents ([clomipramine](https://en.wikipedia.org/wiki/Clomipramine "Clomipramine"), [imipramine](https://en.wikipedia.org/wiki/Imipramine "Imipramine"), clonazepam, [alprazolam](https://en.wikipedia.org/wiki/Alprazolam "Alprazolam"), and [fluvoxamine](https://en.wikipedia.org/wiki/Fluvoxamine "Fluvoxamine")) indicates approximate equivalence of these medications.[\[55\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid10945134-55) ### Other anxiety disorders \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=7 "Edit section: Other anxiety disorders")\] Sertraline has been successfully used for the treatment of [social anxiety disorder](https://en.wikipedia.org/wiki/Social_anxiety_disorder "Social anxiety disorder").[\[61\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-61)[\[62\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid17092192-62) All three major domains of the disorder (fear, avoidance, and physiological symptoms) respond to sertraline.[\[31\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid21456103-31) Maintenance treatment, after the response is achieved, prevents the return of the symptoms.[\[63\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid18374843-63) The improvement is greater among the patients with later, adult onset of the disorder.[\[64\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid17963189-64) In a comparison trial, sertraline was superior to [exposure therapy](https://en.wikipedia.org/wiki/Exposure_therapy "Exposure therapy"), but patients treated with the psychological intervention continued to improve during a year-long follow-up, while those treated with sertraline deteriorated after treatment termination.[\[65\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16318597-65) The combination of sertraline and [cognitive behavioral therapy](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy") appears to be more effective in children and young people than either treatment alone.[\[66\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid23834458-66) Sertraline has not been approved for the treatment of [generalized anxiety disorder](https://en.wikipedia.org/wiki/Generalized_anxiety_disorder "Generalized anxiety disorder"); however, several guidelines recommend it as a first-line medication referring to good quality controlled clinical trials.[\[67\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-nice-gad-67)[\[43\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12516310-43)[\[52\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid25081580-52) ### Premenstrual dysphoric disorder \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=8 "Edit section: Premenstrual dysphoric disorder")\] Sertraline is effective in alleviating the symptoms of [premenstrual dysphoric disorder](https://en.wikipedia.org/wiki/Premenstrual_dysphoric_disorder "Premenstrual dysphoric disorder"), a severe form of [premenstrual syndrome](https://en.wikipedia.org/wiki/Premenstrual_syndrome "Premenstrual syndrome").[\[68\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Jespersen_2024-68) Significant improvement was observed in 50–60% of cases treated with sertraline vs. 20–30% of cases on placebo. The improvement began during the first week of treatment, and in addition to mood, irritability, and anxiety, improvement was reflected in better family functioning, social activity, and general quality of life. Work functioning and physical symptoms, such as swelling, bloating, and breast tenderness, were less responsive to sertraline.[\[69\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12215058-69)[\[70\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11972726-70) Taking sertraline only during the [luteal phase](https://en.wikipedia.org/wiki/Luteal_phase "Luteal phase"), that is, the 12–14 days before menses is not as effective as continuous treatment.[\[68\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Jespersen_2024-68) Continuous treatment with sub-therapeutic doses of sertraline (25 mg vs. usual 50–100 mg) is also effective.[\[71\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid26377947-71) Sertraline is approved for the treatment of [post-traumatic stress disorder](https://en.wikipedia.org/wiki/Post-traumatic_stress_disorder "Post-traumatic stress disorder") (PTSD).[\[23\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-DailyMed-23) The [National Institute for Clinical Excellence](https://en.wikipedia.org/wiki/National_Institute_for_Clinical_Excellence "National Institute for Clinical Excellence") recommends it for patients who prefer drug treatment to a psychological one.[\[72\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-NICE-PTSD-72) Other guidelines also suggest sertraline as a first-line option for [pharmacological therapy](https://en.wikipedia.org/wiki/Pharmacological_therapy "Pharmacological therapy").[\[73\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16734498-73)[\[43\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12516310-43) When necessary, long-term pharmacotherapy can be beneficial.[\[73\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16734498-73) There are both negative and positive clinical trial results for sertraline, which may be explained by the types of [psychological traumas](https://en.wikipedia.org/wiki/Psychological_trauma "Psychological trauma"), symptoms, and [comorbidities](https://en.wikipedia.org/wiki/Comorbidity "Comorbidity") included in the various studies.[\[52\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid25081580-52) Positive results were obtained in trials that included predominantly women (75%) with a majority (60%) having physical or sexual assault as the traumatic event.[\[73\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16734498-73) Somewhat contrary to the above suggestions, a meta-analysis of sertraline clinical trials for PTSD found it to be statistically superior to placebo in the reduction of PTSD symptoms but the effect size was small.[\[12\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid25644881-12) Another meta-analysis relegated sertraline to the second line, proposing [trauma focused psychotherapy](https://en.wikipedia.org/wiki/Trauma_focused_cognitive_behavioral_therapy "Trauma focused cognitive behavioral therapy") as a first-line intervention. The authors noted that [Pfizer](https://en.wikipedia.org/wiki/Pfizer "Pfizer") had declined to submit the results of a negative trial for inclusion in the meta-analysis making the results unreliable.[\[13\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid27126398-13) Sertraline, when taken daily, can be useful for the treatment of [premature ejaculation](https://en.wikipedia.org/wiki/Premature_ejaculation "Premature ejaculation").[\[74\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-74) A disadvantage of sertraline is that it requires continuous daily treatment to delay ejaculation significantly.[\[75\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid17983899-75) A 2019 [systematic review](https://en.wikipedia.org/wiki/Systematic_review "Systematic review") suggested that sertraline may be a good way to control [anger](https://en.wikipedia.org/wiki/Anger "Anger"), [irritability](https://en.wikipedia.org/wiki/Irritability "Irritability"), and [hostility](https://en.wikipedia.org/wiki/Hostility "Hostility") in depressed patients and patients with other comorbidities.[\[76\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid31126061-76) Sertraline is contraindicated in individuals taking [monoamine oxidase inhibitors](https://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor "Monoamine oxidase inhibitor") or the antipsychotic [pimozide](https://en.wikipedia.org/wiki/Pimozide "Pimozide"). Liquid formulations of sertraline contain [ethanol](https://en.wikipedia.org/wiki/Alcohol_\(medicine\) "Alcohol (medicine)") and are therefore contraindicated with [disulfiram](https://en.wikipedia.org/wiki/Disulfiram "Disulfiram"). The prescribing information recommends that treatment of the elderly and patients with liver impairment "must be approached with caution". Due to the slower elimination of sertraline in these groups, their exposure to sertraline may be as high as three times the average exposure for the same dose.[\[23\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-DailyMed-23) Nausea, ejaculation failure, insomnia, diarrhea, dry mouth, somnolence, dizziness, tremor, headache, excessive sweating, fatigue, [restless legs syndrome](https://en.wikipedia.org/wiki/Restless_legs_syndrome "Restless legs syndrome") and decreased [libido](https://en.wikipedia.org/wiki/Libido "Libido") are the common adverse effects associated with sertraline with the greatest difference from [placebo](https://en.wikipedia.org/wiki/Placebo "Placebo"). Those that most often result in interruption of the treatment are nausea, diarrhea, and insomnia.[\[23\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-DailyMed-23) The incidence of diarrhea is higher with sertraline – especially when prescribed at higher doses – in comparison with other [SSRIs](https://en.wikipedia.org/wiki/SSRIs "SSRIs").[\[77\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-ICP2014-77) Over more than six months of sertraline therapy for depression, people showed no significant weight increase.[\[78\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11105740-78) A 30-month-long treatment with sertraline for OCD also resulted in no significant weight gain.[\[79\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid15491240-79) Although the difference did not reach [statistical significance](https://en.wikipedia.org/wiki/Statistical_significance "Statistical significance"), the average weight gain was lower for [fluoxetine](https://en.wikipedia.org/wiki/Fluoxetine "Fluoxetine") (1%) but higher for [citalopram](https://en.wikipedia.org/wiki/Citalopram "Citalopram"), [fluvoxamine](https://en.wikipedia.org/wiki/Fluvoxamine "Fluvoxamine") and [paroxetine](https://en.wikipedia.org/wiki/Paroxetine "Paroxetine") (2.5%). Of the sertraline group, 4.5% gained a large amount of weight (defined as more than 7% gain). This result compares favorably with placebo, where, according to the literature, 3–6% of patients gained more than 7% of their initial weight. The large weight gain was observed only among female members of the sertraline group; the significance of this finding is unclear because of the small size of the group.[\[79\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid15491240-79) Over a two-week treatment of healthy volunteers, sertraline slightly improved verbal [fluency](https://en.wikipedia.org/wiki/Fluency "Fluency") but did not affect word learning, [short-term memory](https://en.wikipedia.org/wiki/Short-term_memory "Short-term memory"), [vigilance](https://en.wikipedia.org/wiki/Alertness "Alertness"), [flicker fusion time](https://en.wikipedia.org/wiki/Flicker_fusion_threshold "Flicker fusion threshold"), choice [reaction time](https://en.wikipedia.org/wiki/Reaction_time "Reaction time"), [memory span](https://en.wikipedia.org/wiki/Memory_span "Memory span"), or [psychomotor coordination](https://en.wikipedia.org/wiki/Motor_coordination "Motor coordination").[\[80\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11565624-80)[\[81\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12692706-81) In spite of lower subjective rating, that is, feeling that they performed worse, no clinically relevant differences were observed in the objective cognitive performance in a group of people treated for depression with sertraline for 1.5 years as compared to healthy controls.[\[82\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16485140-82) In children and adolescents taking sertraline for six weeks for anxiety disorders, 18 out of 20 measures of memory, attention, and alertness stayed unchanged. [Divided attention](https://en.wikipedia.org/wiki/Attention#Clinical_model "Attention") was improved and [verbal memory](https://en.wikipedia.org/wiki/Verbal_memory "Verbal memory") under [interference conditions](https://en.wikipedia.org/wiki/Interference_theory#Proactive_interference "Interference theory") decreased marginally. Because of the large number of measures taken, it is possible that these changes were still due to chance.[\[83\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16190792-83) The unique effect of sertraline on [dopaminergic](https://en.wikipedia.org/wiki/Dopaminergic "Dopaminergic") [neurotransmission](https://en.wikipedia.org/wiki/Neurotransmission "Neurotransmission") may be related to these effects on cognition and vigilance.[\[84\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-84)[\[85\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-85) Sertraline has a low level of exposure of an infant through the breast milk and is recommended as the preferred option for the antidepressant therapy of breast-feeding mothers.[\[86\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-86)[\[87\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid28440103-87) However, there is 29–42% increase in [congenital heart defects](https://en.wikipedia.org/wiki/Congenital_heart_defect "Congenital heart defect") among children whose mothers were prescribed sertraline during pregnancy,[\[16\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid30415641-16)[\[17\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid33354752-17) with sertraline use in the first trimester associated with 2.7-fold increase in [septal heart defects](https://en.wikipedia.org/wiki/Heart_septal_defect "Heart septal defect").[\[16\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid30415641-16) Abrupt interruption of sertraline treatment may result in [withdrawal or discontinuation syndrome](https://en.wikipedia.org/wiki/Antidepressant_discontinuation_syndrome "Antidepressant discontinuation syndrome"). Dizziness, insomnia, anxiety, agitation, and irritability are common symptoms.[\[88\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid23596418-88) It typically occurs within a few days from drug discontinuation and lasts a few weeks.[\[89\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid25721705-89) The withdrawal symptoms for sertraline are less severe and frequent than for paroxetine, and more frequent than for [fluoxetine](https://en.wikipedia.org/wiki/Fluoxetine "Fluoxetine").[\[88\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid23596418-88)[\[89\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid25721705-89) In most cases symptoms are mild, short-lived, and resolve without treatment. More severe cases are often successfully treated by temporary reintroduction of the drug with a slower tapering-off rate.[\[90\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-WarnerAFP-90) Sertraline and SSRI antidepressants in general may be associated with [bruxism](https://en.wikipedia.org/wiki/Bruxism "Bruxism") and other [movement disorders](https://en.wikipedia.org/wiki/Movement_disorders "Movement disorders").[\[91\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid32546134-91)[\[92\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-92) Sertraline appears to be associated with [microscopic colitis](https://en.wikipedia.org/wiki/Microscopic_colitis "Microscopic colitis"), a rare condition of unknown [etiology](https://en.wikipedia.org/wiki/Etiology "Etiology").[\[93\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid30881078-93) Like other SSRIs, sertraline is associated with sexual side effects, including [sexual arousal disorder](https://en.wikipedia.org/wiki/Sexual_arousal_disorder "Sexual arousal disorder"), [erectile dysfunction](https://en.wikipedia.org/wiki/Erectile_dysfunction "Erectile dysfunction") and difficulty achieving [orgasm](https://en.wikipedia.org/wiki/Orgasm "Orgasm"). While [nefazodone](https://en.wikipedia.org/wiki/Nefazodone "Nefazodone") and [bupropion](https://en.wikipedia.org/wiki/Bupropion "Bupropion") do not have negative effects on sexual functioning, 67% of men on sertraline experienced ejaculation difficulties versus 18% before the treatment.[\[94\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11229450-94) [Sexual arousal](https://en.wikipedia.org/wiki/Sexual_arousal "Sexual arousal") disorder, defined as "inadequate lubrication and swelling for women and erectile difficulties for men", occurred in 12% of people on sertraline as compared with 1% of patients on placebo. The mood improvement resulting from the treatment with sertraline sometimes counteracted these side effects, so that [sexual desire](https://en.wikipedia.org/wiki/Sexual_desire "Sexual desire") and overall satisfaction with sex stayed the same as before the sertraline treatment. However, under the action of placebo the desire and satisfaction slightly improved.[\[95\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid10363731-95). ### Post-SSRI sexual dysfunction \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=13 "Edit section: Post-SSRI sexual dysfunction")\] [Post-SSRI sexual dysfunction](https://en.wikipedia.org/wiki/Post-SSRI_sexual_dysfunction "Post-SSRI sexual dysfunction") (PSSD) is an [iatrogenic](https://en.wikipedia.org/wiki/Iatrogenic "Iatrogenic") condition in which sexual side effects persist after discontinuation of serotonin reuptake inhibiting antidepressants, including sertraline.[\[96\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Bala2018-96)[\[14\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Healy2022-14) Characteristic symptoms include genital numbness, pleasureless or weak orgasm, loss of libido, and [erectile dysfunction](https://en.wikipedia.org/wiki/Erectile_dysfunction "Erectile dysfunction"); non-sexual symptoms such as [emotional blunting](https://en.wikipedia.org/wiki/Emotional_blunting "Emotional blunting") and cognitive impairment may also occur.[\[14\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Healy2022-14) The condition can arise after even brief exposure to a serotonin reuptake inhibitor and may persist indefinitely; there is currently no established treatment.[\[97\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Healy2018-97) The [DSM-5](https://en.wikipedia.org/wiki/DSM-5 "DSM-5") noted in 2013 that serotonin reuptake inhibitor-induced sexual dysfunction may persist after the agent is discontinued.[\[98\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Healy2024barriers-98) The UK's [Medicines and Healthcare products Regulatory Agency](https://en.wikipedia.org/wiki/Medicines_and_Healthcare_products_Regulatory_Agency "Medicines and Healthcare products Regulatory Agency") received its first report of a sexual dysfunction persisting after an SSRI was stopped — involving [fluoxetine](https://en.wikipedia.org/wiki/Fluoxetine "Fluoxetine") — in 1991, and sertraline has been among the SSRIs most frequently implicated in subsequent reports.[\[98\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Healy2024barriers-98) A 2023 retrospective cohort study of over 12,000 males estimated the risk of irreversible sexual dysfunction at approximately 0.46% of patients treated with serotonergic antidepressants, including SSRIs, though the actual prevalence remains uncertain and the condition is likely underreported.[\[99\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-BenSheetrit2023-99) A 2023 systematic review found that nearly every SSRI currently marketed has been associated with reports of PSSD, with escitalopram, citalopram, paroxetine, sertraline, and fluoxetine accounting for the majority of reported cases.[\[100\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Tarchi2023-100) In 2019, the [European Medicines Agency](https://en.wikipedia.org/wiki/European_Medicines_Agency "European Medicines Agency")'s [Pharmacovigilance Risk Assessment Committee](https://en.wikipedia.org/wiki/Pharmacovigilance_Risk_Assessment_Committee "Pharmacovigilance Risk Assessment Committee") (PRAC) recommended that product labels for all SSRIs and SNRIs, including sertraline, be updated to state that sexual dysfunction may be long-lasting even after treatment is stopped.[\[15\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-PRAC2019-15) [Health Canada](https://en.wikipedia.org/wiki/Health_Canada "Health Canada") followed with similar label updates in 2021.[\[98\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Healy2024barriers-98) In 2024, Australia's [Therapeutic Goods Administration](https://en.wikipedia.org/wiki/Therapeutic_Goods_Administration "Therapeutic Goods Administration") aligned all SSRI and SNRI product information to reflect this risk, noting that sertraline already carried a warning about persistent sexual dysfunction.[\[101\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-TGA2024-101) The US [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) requires all antidepressants, including sertraline, to carry a [boxed warning](https://en.wikipedia.org/wiki/Boxed_warning "Boxed warning") stating that antidepressants increase the risk of suicide in persons younger than 25 years.[\[102\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-102)[\[103\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-103)[\[104\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-104) This warning is based on statistical analyses conducted by two independent groups of FDA experts that found a 100% increase of suicidal thoughts and behavior in children and adolescents, and a 50% increase in the 18–24 age group.[\[105\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDA-105)[\[106\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDA2-106)[\[107\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDA3-107) [Suicidal ideation](https://en.wikipedia.org/wiki/Suicidal_ideation "Suicidal ideation") and behavior in clinical trials are rare. For the above analysis, the FDA combined the results of 295 trials of 11 antidepressants for psychiatric indications to obtain [statistically significant](https://en.wikipedia.org/wiki/Statistically_significant "Statistically significant") results. Considered separately, sertraline use in adults decreased the odds of suicidal behavior with a marginal statistical significance of 37%[\[107\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDA3-107) or 50%[\[106\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDA2-106) depending on the statistical technique used. The authors of the FDA analysis note that "given the large number of comparisons made in this review, chance is a very plausible explanation for this difference".[\[106\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDA2-106) The more complete data submitted later by the sertraline manufacturer Pfizer indicated increased suicidal behavior.[\[108\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-108) Similarly, the analysis conducted by the UK [MHRA](https://en.wikipedia.org/wiki/Medicines_and_Healthcare_products_Regulatory_Agency "Medicines and Healthcare products Regulatory Agency") found a 50% increase of odds of suicide-related events, not reaching statistical significance, in the patients on sertraline as compared to the ones on placebo.[\[109\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-109)[\[110\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid15718537-110) The therapeutic dosage varies according to the patient's age and/or clinical condition, but for all treatments with sertraline, it is recommended to start with lower dosages (25 to 50 mg/daily) and adjust according to the patient's therapeutic response, with a maximum maintenance dose of up to 200 mg per day.[\[111\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-111) Acute overdosage is often manifested by [emesis](https://en.wikipedia.org/wiki/Emesis "Emesis"), [lethargy](https://en.wikipedia.org/wiki/Lethargy "Lethargy"), [ataxia](https://en.wikipedia.org/wiki/Ataxia "Ataxia"), [tachycardia](https://en.wikipedia.org/wiki/Tachycardia "Tachycardia") and [seizures](https://en.wikipedia.org/wiki/Seizures "Seizures"). Plasma, serum or blood concentrations of sertraline and norsertraline, its major [active metabolite](https://en.wikipedia.org/wiki/Active_metabolite "Active metabolite"), may be measured to confirm a diagnosis of poisoning in hospitalized patients or to aid in the medicolegal investigation of fatalities.[\[112\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-112) As with most other SSRIs its toxicity in overdose is considered relatively low.[\[113\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Maudsley-113)[\[114\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-114) As with other SSRIs, sertraline may increase the risk of bleeding with [NSAIDs](https://en.wikipedia.org/wiki/Nonsteroidal_anti-inflammatory_drug "Nonsteroidal anti-inflammatory drug") ([ibuprofen](https://en.wikipedia.org/wiki/Ibuprofen "Ibuprofen"), [naproxen](https://en.wikipedia.org/wiki/Naproxen "Naproxen"), [mefenamic acid](https://en.wikipedia.org/wiki/Mefenamic_acid "Mefenamic acid")), [antiplatelet drugs](https://en.wikipedia.org/wiki/Antiplatelet_drug "Antiplatelet drug"), [anticoagulants](https://en.wikipedia.org/wiki/Anticoagulant "Anticoagulant"), [omega-3 fatty acids](https://en.wikipedia.org/wiki/Omega-3_fatty_acid "Omega-3 fatty acid"), [vitamin E](https://en.wikipedia.org/wiki/Vitamin_E "Vitamin E"), and garlic [supplements](https://en.wikipedia.org/wiki/Dietary_supplement "Dietary supplement") due to sertraline's inhibitory effects on [platelet aggregation](https://en.wikipedia.org/wiki/Platelet_aggregation "Platelet aggregation") via blocking [serotonin transporters](https://en.wikipedia.org/wiki/Serotonin_transporter "Serotonin transporter") on platelets.[\[115\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-115) Sertraline, in particular, may potentially diminish the efficacy of [levothyroxine](https://en.wikipedia.org/wiki/Levothyroxine "Levothyroxine").[\[116\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-116) Sertraline is a moderate [inhibitor](https://en.wikipedia.org/wiki/Enzyme_inhibitor "Enzyme inhibitor") of [CYP2D6](https://en.wikipedia.org/wiki/CYP2D6 "CYP2D6") and [CYP2B6](https://en.wikipedia.org/wiki/CYP2B6 "CYP2B6") *[in vitro](https://en.wikipedia.org/wiki/In_vitro "In vitro")*.[\[7\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16192315-7) Accordingly, in human trials it caused increased blood levels of CYP2D6 [substrates](https://en.wikipedia.org/wiki/Substrate_\(biochemistry\) "Substrate (biochemistry)") such as [metoprolol](https://en.wikipedia.org/wiki/Metoprolol "Metoprolol"), [dextromethorphan](https://en.wikipedia.org/wiki/Dextromethorphan "Dextromethorphan"), [desipramine](https://en.wikipedia.org/wiki/Desipramine "Desipramine"), [imipramine](https://en.wikipedia.org/wiki/Imipramine "Imipramine") and [nortriptyline](https://en.wikipedia.org/wiki/Nortriptyline "Nortriptyline"), as well as the [CYP3A4](https://en.wikipedia.org/wiki/CYP3A4 "CYP3A4")/CYP2D6 substrate [haloperidol](https://en.wikipedia.org/wiki/Haloperidol "Haloperidol").[\[117\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9472843-117)[\[118\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid10211917-118)[\[119\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid10631623-119) This effect is dose-dependent; for example, co-administration with 50 mg of sertraline resulted in 20% greater exposure to desipramine, while 150 mg of sertraline led to a 70% increase.[\[8\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12452737-8)[\[120\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid17224709-120) In a placebo-controlled study, the concomitant administration of sertraline and [methadone](https://en.wikipedia.org/wiki/Methadone "Methadone") caused a 40% increase in blood levels of the latter, which is primarily metabolized by CYP2B6.[\[121\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid10914294-121) [Bupropion](https://en.wikipedia.org/wiki/Bupropion "Bupropion") is metabolized by CYP2B6, which is inhibited by sertraline, and this may result in an interaction between sertraline and bupropion.[\[122\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-TurpeinenZanger2012-122)[\[123\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-SchatzbergHemeroff2024-123)[\[124\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-MolnariHassanMyers2012-124) Sertraline had a slight inhibitory effect on the metabolism of [diazepam](https://en.wikipedia.org/wiki/Diazepam "Diazepam"), [tolbutamide](https://en.wikipedia.org/wiki/Tolbutamide "Tolbutamide"), and [warfarin](https://en.wikipedia.org/wiki/Warfarin "Warfarin"), which are [CYP2C9](https://en.wikipedia.org/wiki/CYP2C9 "CYP2C9") or [CYP2C19](https://en.wikipedia.org/wiki/CYP2C19 "CYP2C19") substrates; the clinical relevance of this effect was unclear.[\[8\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12452737-8) As expected from *in vitro* data, sertraline did not alter the human metabolism of the CYP3A4 substrates [erythromycin](https://en.wikipedia.org/wiki/Erythromycin "Erythromycin"), [alprazolam](https://en.wikipedia.org/wiki/Alprazolam "Alprazolam"), [carbamazepine](https://en.wikipedia.org/wiki/Carbamazepine "Carbamazepine"), [clonazepam](https://en.wikipedia.org/wiki/Clonazepam "Clonazepam"), and [terfenadine](https://en.wikipedia.org/wiki/Terfenadine "Terfenadine"); neither did it affect metabolism of the [CYP1A2](https://en.wikipedia.org/wiki/CYP1A2 "CYP1A2") substrate [clozapine](https://en.wikipedia.org/wiki/Clozapine "Clozapine").[\[8\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12452737-8)[\[23\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-DailyMed-23)[\[125\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid14709940-125)[\[7\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid16192315-7) Sertraline did not affect the actions of [digoxin](https://en.wikipedia.org/wiki/Digoxin "Digoxin") and [atenolol](https://en.wikipedia.org/wiki/Atenolol "Atenolol"), which are not metabolized in the liver.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) [Case reports](https://en.wikipedia.org/wiki/Case_report "Case report") suggest that taking sertraline with [phenytoin](https://en.wikipedia.org/wiki/Phenytoin "Phenytoin") or [zolpidem](https://en.wikipedia.org/wiki/Zolpidem "Zolpidem") may induce sertraline metabolism and decrease its efficacy,[\[126\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-126)[\[127\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-127) and that taking sertraline with [lamotrigine](https://en.wikipedia.org/wiki/Lamotrigine "Lamotrigine") may increase the blood level of lamotrigine, possibly by inhibition of glucuronidation.[\[128\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9627209-128) CYP2C19 inhibitor [esomeprazole](https://en.wikipedia.org/wiki/Esomeprazole "Esomeprazole") increased sertraline concentrations in blood plasma by approximately 40%.[\[129\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid24887634-129) Clinical reports indicate that interaction between sertraline and the [MAOIs](https://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor "Monoamine oxidase inhibitor") [isocarboxazid](https://en.wikipedia.org/wiki/Isocarboxazid "Isocarboxazid") and [tranylcypromine](https://en.wikipedia.org/wiki/Tranylcypromine "Tranylcypromine") may cause [serotonin syndrome](https://en.wikipedia.org/wiki/Serotonin_syndrome "Serotonin syndrome"). In a placebo-controlled study in which sertraline was co-administered with [lithium](https://en.wikipedia.org/wiki/Lithium_pharmacology "Lithium pharmacology"), 35% of the subjects experienced tremors, while none of those taking placebo did.[\[8\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12452737-8) | Site | *K*i (nM) | Species | References | |---|---|---|---| | [SERT](https://en.wikipedia.org/wiki/Serotonin_transporter "Serotonin transporter")Tooltip Serotonin transporter | 0\.15–3.3 | Human | [\[131\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9537821-131)[\[132\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9400006-132)[\[133\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11543737-133) | | [NET](https://en.wikipedia.org/wiki/Norepinephrine_transporter "Norepinephrine transporter")Tooltip Norepinephrine transporter | 420–925 | Human | [\[131\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9537821-131)[\[132\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9400006-132)[\[133\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11543737-133) | | [DAT](https://en.wikipedia.org/wiki/Dopamine_transporter "Dopamine transporter")Tooltip Dopamine transporter | 22–315 | Human | [\[131\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9537821-131)[\[132\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9400006-132)[\[133\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11543737-133) | | [5-HT1A](https://en.wikipedia.org/wiki/5-HT1A_receptor "5-HT1A receptor") | 35000+ | Human | [\[134\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid7855217-134) | | [5-HT2A](https://en.wikipedia.org/wiki/5-HT2A_receptor "5-HT2A receptor") | 2207 | Rat | [\[133\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11543737-133) | | [5-HT2C](https://en.wikipedia.org/wiki/5-HT2C_receptor "5-HT2C receptor") | 2298 | Pig | [\[133\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11543737-133) | | [α1A](https://en.wikipedia.org/wiki/Alpha-1A_adrenergic_receptor "Alpha-1A adrenergic receptor") | 1900 | Human | [\[135\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid32608144-135) | | [α1B](https://en.wikipedia.org/wiki/Alpha-1B_adrenergic_receptor "Alpha-1B adrenergic receptor") | 3500 | Human | [\[135\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid32608144-135) | | [α1D](https://en.wikipedia.org/wiki/Alpha-1D_adrenergic_receptor "Alpha-1D adrenergic receptor") | 2500 | Human | [\[135\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid32608144-135) | | [α2](https://en.wikipedia.org/wiki/Alpha-2_adrenergic_receptor "Alpha-2 adrenergic receptor") | 477–4100 | Human | [\[132\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9400006-132)[\[134\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid7855217-134) | | [D2](https://en.wikipedia.org/wiki/D2_receptor "D2 receptor") | 10700 | Human | [\[134\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid7855217-134) | | [H1](https://en.wikipedia.org/wiki/Histamine_H1_receptor "Histamine H1 receptor") | 24000 | Human | [\[134\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid7855217-134) | | [mACh](https://en.wikipedia.org/wiki/Muscarinic_acetylcholine_receptors "Muscarinic acetylcholine receptors")Tooltip Muscarinic acetylcholine receptors | 427–2100 | Human | [\[133\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11543737-133)[\[134\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid7855217-134)[\[136\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid8100134-136) | | [σ1](https://en.wikipedia.org/wiki/Sigma-1_receptor "Sigma-1 receptor") | 32–57 | Rat | [\[137\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-AlbayrakHashimoto2017-137)[\[138\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid20373470-138) | | [σ2](https://en.wikipedia.org/wiki/Sigma-2_receptor "Sigma-2 receptor") | 5297 | Rat | [\[138\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid20373470-138) | | Values are *K*i (nM), unless otherwise noted. The smaller the value, the more strongly the drug binds to or inhibits the site. | | | | Sertraline is a [selective serotonin reuptake inhibitor](https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor "Selective serotonin reuptake inhibitor") (SSRI). By binding to the [serotonin transporter](https://en.wikipedia.org/wiki/Serotonin_transporter "Serotonin transporter") (SERT) it inhibits neuronal [reuptake](https://en.wikipedia.org/wiki/Reuptake "Reuptake") of [serotonin](https://en.wikipedia.org/wiki/Serotonin "Serotonin") and potentiates serotonergic activity in the [central nervous system](https://en.wikipedia.org/wiki/Central_nervous_system "Central nervous system").[\[23\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-DailyMed-23) Over time, this leads to a downregulation of pre-synaptic [5-HT1A](https://en.wikipedia.org/wiki/5-HT1A_receptor "5-HT1A receptor") receptors, which is associated with an improvement in passive stress tolerance, and delayed downstream increase in expression of [brain-derived neurotrophic factor](https://en.wikipedia.org/wiki/Brain-derived_neurotrophic_factor "Brain-derived neurotrophic factor") (BDNF), which may contribute to a reduction in negative affective biases.[\[139\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-139)[\[140\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-140) It does not significantly affect [histamine](https://en.wikipedia.org/wiki/Histamine_receptor "Histamine receptor"), [acetylcholine](https://en.wikipedia.org/wiki/Acetylcholine_receptor "Acetylcholine receptor"), [GABA](https://en.wikipedia.org/wiki/GABA_receptor "GABA receptor") or [benzodiazepine](https://en.wikipedia.org/wiki/Benzodiazepine "Benzodiazepine") receptors.[\[23\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-DailyMed-23) Sertraline also shows relatively high activity as an inhibitor of the [dopamine transporter](https://en.wikipedia.org/wiki/Dopamine_transporter "Dopamine transporter") (DAT) occupying ~20% of DAT receptors at doses 200mg and above,[\[131\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9537821-131)[\[141\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11357798-141)[\[142\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-HemmingsEgan2012-142) and antagonist of the [sigma](https://en.wikipedia.org/wiki/Sigma_receptor "Sigma receptor") [σ1 receptor](https://en.wikipedia.org/wiki/Sigma-1_receptor "Sigma-1 receptor") (but not the [σ2 receptor](https://en.wikipedia.org/wiki/Sigma-2_receptor "Sigma-2 receptor")).[\[137\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-AlbayrakHashimoto2017-137)[\[138\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid20373470-138)[\[143\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid20021354-143) However, sertraline affinity for its main target (SERT) is much greater than its affinity for σ1 receptor and DAT.[\[130\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-PDSP-130)[\[131\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9537821-131)[\[138\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid20373470-138)[\[137\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-AlbayrakHashimoto2017-137) Although there could be a role for the σ1 receptor in the [pharmacology](https://en.wikipedia.org/wiki/Pharmacology "Pharmacology") of sertraline, the significance of this receptor in its actions is unclear.[\[34\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid11420570-34) Similarly, the clinical relevance of sertraline's blockade of the dopamine transporter is uncertain.[\[131\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9537821-131) Sertraline is a REDD1-dependent [mTOR inhibitor](https://en.wikipedia.org/wiki/MTOR_inhibitors "MTOR inhibitors"). It blocks [AKT](https://en.wikipedia.org/wiki/Protein_kinase_B "Protein kinase B")/mTOR pathway and has [autophagy](https://en.wikipedia.org/wiki/Autophagy "Autophagy")\-inducing activity.[\[144\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-144)[\[145\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-145)[\[146\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-146)[\[147\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-147) [![](https://upload.wikimedia.org/wikipedia/commons/thumb/b/bf/Desmethylsertraline_skeletal.svg/250px-Desmethylsertraline_skeletal.svg.png)](https://en.wikipedia.org/wiki/File:Desmethylsertraline_skeletal.svg) [Desmethylsertraline](https://en.wikipedia.org/wiki/Desmethylsertraline "Desmethylsertraline"), the major [metabolite](https://en.wikipedia.org/wiki/Metabolite "Metabolite") of sertraline Following a single oral dose of sertraline, mean peak blood levels of sertraline occur between 4.5 and 8.4 hours.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) [Bioavailability](https://en.wikipedia.org/wiki/Bioavailability "Bioavailability") is likely linear and dose-proportional over a dose range of 150 to 200 mg.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) Concomitant intake of sertraline with food slightly increases sertraline peak levels and total exposure.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) There is an approximate 2-fold accumulation of sertraline with continuous administration and [steady-state levels](https://en.wikipedia.org/wiki/Steady_state_\(pharmacokinetics\) "Steady state (pharmacokinetics)") are reached within one week.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) Sertraline is highly [plasma protein bound](https://en.wikipedia.org/wiki/Plasma_protein_binding "Plasma protein binding") (98.5%) across a concentration range of 20 to 500 ng/mL.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) Despite the high plasma protein binding, sertraline and its [metabolite](https://en.wikipedia.org/wiki/Metabolite "Metabolite") [desmethylsertraline](https://en.wikipedia.org/wiki/Desmethylsertraline "Desmethylsertraline") at respective tested concentrations of 300 ng/mL and 200 ng/mL were found not to interfere with the plasma protein binding of [warfarin](https://en.wikipedia.org/wiki/Warfarin "Warfarin") and [propranolol](https://en.wikipedia.org/wiki/Propranolol "Propranolol"), two other highly plasma protein-bound drugs.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) Sertraline is subject to extensive [first-pass metabolism](https://en.wikipedia.org/wiki/First-pass_metabolism "First-pass metabolism"), as indicated by a small study of [radiolabeled](https://en.wikipedia.org/wiki/Radiolabel "Radiolabel") sertraline in which less than 5% of plasma [radioactivity](https://en.wikipedia.org/wiki/Radioactivity "Radioactivity") was unchanged sertraline in two males.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) The principal [metabolic pathway](https://en.wikipedia.org/wiki/Metabolic_pathway "Metabolic pathway") for sertraline is [*N*\-demethylation](https://en.wikipedia.org/wiki/Demethylation "Demethylation") into [desmethylsertraline](https://en.wikipedia.org/wiki/Desmethylsertraline "Desmethylsertraline") (*N*\-desmethylsertraline) mainly by [CYP2B6](https://en.wikipedia.org/wiki/CYP2B6 "CYP2B6").[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5)[\[9\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid15547048-9) [Reduction](https://en.wikipedia.org/wiki/Redox "Redox"), [hydroxylation](https://en.wikipedia.org/wiki/Hydroxylation "Hydroxylation"), and [glucuronide](https://en.wikipedia.org/wiki/Glucuronidation "Glucuronidation") [conjugation](https://en.wikipedia.org/wiki/Conjugation_\(biochemistry\) "Conjugation (biochemistry)") of both sertraline and desmethylsertraline also occur.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) Desmethylsertraline, while [pharmacologically active](https://en.wikipedia.org/wiki/Pharmacologically_active "Pharmacologically active"), is substantially (50-fold) weaker than sertraline as a [serotonin reuptake inhibitor](https://en.wikipedia.org/wiki/Serotonin_reuptake_inhibitor "Serotonin reuptake inhibitor") and its influence on the clinical effects of sertraline is thought to be negligible.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5)[\[132\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid9400006-132)[\[148\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-In_Vivo_SERT_binding-148) Based on *[in vitro](https://en.wikipedia.org/wiki/In_vitro "In vitro")* studies, sertraline is [metabolized](https://en.wikipedia.org/wiki/Metabolism "Metabolism") by multiple [cytochrome 450](https://en.wikipedia.org/wiki/Cytochrome_450 "Cytochrome 450") [isoforms](https://en.wikipedia.org/wiki/Isoenzyme "Isoenzyme");[\[9\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid15547048-9)[\[149\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid10383917-149) however, it appears that in the human body [CYP2C19](https://en.wikipedia.org/wiki/CYP2C19 "CYP2C19") plays the most important role, followed by [CYP2B6](https://en.wikipedia.org/wiki/CYP2B6 "CYP2B6").[\[150\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid29136336-150) In addition to the cytochrome P450 system, sertraline can be [oxidatively](https://en.wikipedia.org/wiki/Oxidation "Oxidation") [deaminated](https://en.wikipedia.org/wiki/Deamination "Deamination") *[in vitro](https://en.wikipedia.org/wiki/In_vitro "In vitro")* by [monoamine oxidases](https://en.wikipedia.org/wiki/Monoamine_oxidase "Monoamine oxidase");[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) however, this [metabolic pathway](https://en.wikipedia.org/wiki/Metabolic_pathway "Metabolic pathway") has never been studied *[in vivo](https://en.wikipedia.org/wiki/In_vivo "In vivo")*.[\[9\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid15547048-9) The [elimination half-life](https://en.wikipedia.org/wiki/Elimination_half-life "Elimination half-life") of sertraline is on average 26 hours, with a range of 13 to 45 hours.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5)[\[8\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid12452737-8) The elimination half-life of desmethylsertraline is 62 to 104 hours.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) In a small study of two people, sertraline was [excreted](https://en.wikipedia.org/wiki/Excretion "Excretion") to similar degrees in [urine](https://en.wikipedia.org/wiki/Urine "Urine") and [feces](https://en.wikipedia.org/wiki/Feces "Feces") (40 to 45% each within 9 days).[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) Unchanged sertraline was not detectable in urine, whereas 12 to 14% of unchanged sertraline was present in feces.[\[5\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-FDALabel-5) [CYP2C19](https://en.wikipedia.org/wiki/CYP2C19 "CYP2C19") and [CYP2B6](https://en.wikipedia.org/wiki/CYP2B6 "CYP2B6") are thought to be the key [cytochrome P450](https://en.wikipedia.org/wiki/Cytochrome_P450 "Cytochrome P450") [enzymes](https://en.wikipedia.org/wiki/Enzyme "Enzyme") involved in the [metabolism](https://en.wikipedia.org/wiki/Metabolism "Metabolism") of sertraline.[\[150\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid29136336-150) Relative to CYP2C19 [normal (extensive) metabolizers](https://en.wikipedia.org/wiki/Extensive_metabolizer "Extensive metabolizer"), [poor metabolizers](https://en.wikipedia.org/wiki/Poor_metabolizer "Poor metabolizer") have 2.7-fold higher levels of sertraline[\[151\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid31649299-151) and [intermediate metabolizers](https://en.wikipedia.org/wiki/Intermediate_metabolizer "Intermediate metabolizer") have 1.4-fold higher levels.[\[152\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid33237321-152) In contrast, CYP2B6 poor metabolizers have 1.6-fold higher levels of sertraline and intermediate metabolizers have 1.2-fold higher levels.[\[150\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid29136336-150) In terms of [chemical structure](https://en.wikipedia.org/wiki/Chemical_structure "Chemical structure"), sertraline is a [1-aminotetralin](https://en.wikipedia.org/wiki/1-aminotetralin "1-aminotetralin").[\[153\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Kachhadiya_2025-153) Several notable [analogues](https://en.wikipedia.org/wiki/Structural_analog "Structural analog") sertraline are known, including [desmethylsertraline](https://en.wikipedia.org/wiki/Desmethylsertraline "Desmethylsertraline"), [dasotraline](https://en.wikipedia.org/wiki/Dasotraline "Dasotraline"), [tametraline](https://en.wikipedia.org/wiki/Tametraline "Tametraline"), and [lometraline](https://en.wikipedia.org/wiki/Lometraline "Lometraline").[\[153\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Kachhadiya_2025-153) [![](https://upload.wikimedia.org/wikipedia/commons/thumb/0/07/Sertraline_precursors.svg/500px-Sertraline_precursors.svg.png)](https://en.wikipedia.org/wiki/File:Sertraline_precursors.svg) [Skeletal formulae](https://en.wikipedia.org/wiki/Skeletal_formula "Skeletal formula") of thiothixene, lometraline and tametraline, from which sertraline was derived. Commonalities to the structure of sertraline are highlighted in red. The history of sertraline dates back to the early 1970s when [Pfizer](https://en.wikipedia.org/wiki/Pfizer "Pfizer") chemist Reinhard Sarges invented a novel series of psychoactive compounds, including [lometraline](https://en.wikipedia.org/wiki/Lometraline "Lometraline"), based on the structures of the neuroleptics [thiothixene](https://en.wikipedia.org/wiki/Thiothixene "Thiothixene") and [pinoxepin](https://en.wikipedia.org/wiki/Pinoxepin "Pinoxepin").[\[154\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Welch-154)[\[155\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-155) Further work on these compounds led to [tametraline](https://en.wikipedia.org/wiki/Tametraline "Tametraline"), a [norepinephrine](https://en.wikipedia.org/wiki/Norepinephrine_reuptake_inhibitor "Norepinephrine reuptake inhibitor") and weaker [dopamine reuptake inhibitor](https://en.wikipedia.org/wiki/Dopamine_reuptake_inhibitor "Dopamine reuptake inhibitor"). Development of tametraline was soon stopped because of undesired [stimulant](https://en.wikipedia.org/wiki/Stimulant "Stimulant") effects observed in animals. A few years later, in 1977, pharmacologist [Kenneth Koe](https://en.wikipedia.org/wiki/Kenneth_Koe "Kenneth Koe"), after comparing the structural features of a variety of reuptake inhibitors, became interested in the tametraline series. He asked another Pfizer chemist, Willard Welch, to synthesize some previously unexplored tametraline derivatives. Welch generated several potent norepinephrine and [triple reuptake](https://en.wikipedia.org/wiki/Serotonin-noradrenaline-dopamine_reuptake_inhibitor "Serotonin-noradrenaline-dopamine reuptake inhibitor") inhibitors, but to the surprise of the scientists, one representative of the generally inactive [cis-analogs](https://en.wikipedia.org/wiki/Cis-trans_isomerism "Cis-trans isomerism") was a serotonin reuptake inhibitor. Welch then prepared [stereoisomers](https://en.wikipedia.org/wiki/Stereoisomerism "Stereoisomerism") of this compound, which were tested *[in vivo](https://en.wikipedia.org/wiki/In_vivo "In vivo")* by animal [behavioral scientist](https://en.wikipedia.org/wiki/Behavioural_sciences "Behavioural sciences") Albert Weissman. The most potent and selective (+)-isomer[\[a\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-158) was taken into further development and eventually named sertraline. Weissman and Koe recalled that the group did not set up to produce an antidepressant of the SSRI type—in that sense their inquiry was not "very goal driven", and the invention of the sertraline molecule was [serendipitous](https://en.wikipedia.org/wiki/Serendipity#Pharmacology "Serendipity"). According to Welch, they worked outside the mainstream at Pfizer, and even "did not have a formal project team". The group had to overcome initial bureaucratic reluctance to pursue sertraline development, as Pfizer was considering licensing an antidepressant candidate from another company.[\[154\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Welch-154)[\[158\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-159)[\[159\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-160) Sertraline was approved by the US [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) in 1991 based on the recommendation of the Psychopharmacological Drugs Advisory Committee; it had already become available in the [United Kingdom](https://en.wikipedia.org/wiki/United_Kingdom "United Kingdom") the previous year.[\[160\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-He168-161) The FDA committee achieved a consensus that sertraline was safe and effective for the treatment of [major depression](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder"). During the discussion, Paul Leber, the director of the FDA Division of Neuropharmacological Drug Products, noted that granting approval was a "tough decision", since the treatment effect on [outpatients](https://en.wikipedia.org/wiki/Patient#Outpatient_vs_inpatientOutpatients_and_inpatients "Patient") with depression had been "modest to minimal". Other experts emphasized that the drug's effect on inpatients had not differed from [placebo](https://en.wikipedia.org/wiki/Placebo "Placebo") and criticized the poor design of the clinical trials by Pfizer.[\[161\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pdac-162) For example, 40% of participants dropped out of the trials, significantly decreasing their [validity](https://en.wikipedia.org/wiki/Validity_\(statistics\) "Validity (statistics)").[\[162\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid8573661-163) Until 2002, sertraline was only approved for use in adults ages 18 and over; that year, it was approved by the FDA for use in treating children aged 6 or older with severe OCD. In 2003, the UK [Medicines and Healthcare products Regulatory Agency](https://en.wikipedia.org/wiki/Medicines_and_Healthcare_products_Regulatory_Agency "Medicines and Healthcare products Regulatory Agency") issued guidance that, apart from [fluoxetine](https://en.wikipedia.org/wiki/Fluoxetine "Fluoxetine") (Prozac), SSRIs are not suitable for the treatment of depression in patients under 18.[\[163\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-164)[\[164\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-165) However, sertraline can still be used in the UK for the treatment of OCD in children and adolescents.[\[165\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-166) In 2005, the FDA added a [boxed warning](https://en.wikipedia.org/wiki/Boxed_warning "Boxed warning") concerning pediatric suicidal behavior to all [antidepressants](https://en.wikipedia.org/wiki/Antidepressant "Antidepressant"), including sertraline. In 2007, labeling was again changed to add a warning regarding suicidal behavior in young adults ages 18 to 24.[\[166\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-167) ## Society and culture \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=28 "Edit section: Society and culture")\] ### Generic availability \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=29 "Edit section: Generic availability")\] The US patent for Zoloft expired in 2006,[\[167\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-168) and sertraline is available in [generic](https://en.wikipedia.org/wiki/Generic_drug "Generic drug") form and is marketed under many brand names worldwide.[\[1\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Brand2015-1) In the US, Zoloft is marketed by [Viatris](https://en.wikipedia.org/wiki/Viatris "Viatris") after Upjohn was spun off from Pfizer.[\[168\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-169)[\[169\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-170)[\[170\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-171) ### Interest during COVID-19 pandemic \[[edit](https://en.wikipedia.org/w/index.php?title=Sertraline&action=edit&section=31 "Edit section: Interest during COVID-19 pandemic")\] Sertraline has been the most sought-after antidepressant worldwide before, during, and after the [COVID-19 pandemic](https://en.wikipedia.org/wiki/COVID-19_pandemic "COVID-19 pandemic"), according to [Google Trends](https://en.wikipedia.org/wiki/Google_Trends "Google Trends") data. The pandemic has led to an increase in searches for antidepressants, with sertraline, [fluoxetine](https://en.wikipedia.org/wiki/Fluoxetine "Fluoxetine"), [duloxetine](https://en.wikipedia.org/wiki/Duloxetine "Duloxetine"), and [venlafaxine](https://en.wikipedia.org/wiki/Venlafaxine "Venlafaxine") showing the highest search volumes, whereas searches of [citalopram](https://en.wikipedia.org/wiki/Citalopram "Citalopram") decreased during the pandemic.[\[171\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-pmid37731683-172) Sertraline may be useful to treat [murine Zaire ebolavirus](https://en.wikipedia.org/wiki/Murine_Zaire_ebolavirus "Murine Zaire ebolavirus") (murine EBOV).[\[172\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Ebola-treatment-173) The [World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization") (WHO) considers this a promising area of research.[\[172\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Ebola-treatment-173) Lass-Flörl *et al.*, 2003 finds it significantly inhibits [phospholipase B](https://en.wikipedia.org/wiki/Phospholipase_B "Phospholipase B") in the fungal genus *[Candida](https://en.wikipedia.org/wiki/Candida_\(fungus\) "Candida (fungus)")*, reducing [virulence](https://en.wikipedia.org/wiki/Virulence "Virulence").[\[173\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Phospholipase-B-174) Sertraline is also a very effective leishmanicide.[\[174\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Chamber-of-Secrets-175) Specifically, Palit & Ali 2008 find that sertraline kills almost all [promastigotes](https://en.wikipedia.org/wiki/Promastigote "Promastigote") of *[Leishmania donovani](https://en.wikipedia.org/wiki/Leishmania_donovani "Leishmania donovani")*.[\[174\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Chamber-of-Secrets-175) Sertraline is strongly [antibacterial](https://en.wikipedia.org/wiki/Antibacterial "Antibacterial") against some species.[\[174\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Chamber-of-Secrets-175) It is also known to act as a [photosensitizer](https://en.wikipedia.org/wiki/Photosensitizer "Photosensitizer") of bacterial surfaces.[\[175\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Photosensitizers-176) In combination with antibacterials its photosensitization effect reverses [antibacterial resistance](https://en.wikipedia.org/wiki/Antibacterial_resistance "Antibacterial resistance").[\[175\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Photosensitizers-176) As such sertraline shows promise for [food preservation](https://en.wikipedia.org/wiki/Food_preservation "Food preservation").[\[175\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Photosensitizers-176) Lass-Flörl *et al.*, 2003 finds this compound acts as a [fungicide](https://en.wikipedia.org/wiki/Fungicide "Fungicide") against *[Candida parapsilosis](https://en.wikipedia.org/wiki/Candida_parapsilosis "Candida parapsilosis")*.[\[176\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Immunomodulation-177) Its anti-*Cp* effect is indeed due to its [serotonergic](https://en.wikipedia.org/wiki/Serotonin "Serotonin") activity and not its other effects.[\[176\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-Immunomodulation-177) Sertraline is a promising [trypanocide](https://en.wikipedia.org/wiki/Trypanocide "Trypanocide").[\[177\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-tcruz-178) It acts at several different [life stages](https://en.wikipedia.org/wiki/Trypanosoma#Hosts,_life_cycle_and_morphologies "Trypanosoma") and against several [strains](https://en.wikipedia.org/wiki/Strain_\(biology\) "Strain (biology)").[\[177\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-tcruz-178) Sertraline's trypanocidal [mechanism of action](https://en.wikipedia.org/wiki/Mechanism_of_action "Mechanism of action") is by way of interference with [bioenergetics](https://en.wikipedia.org/wiki/Bioenergetics "Bioenergetics").[\[177\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-tcruz-178) When mothers take sertraline during pregnancy, there is research evidence that the newborn may experience sertraline withdrawal symptoms.[\[178\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-179) - [List of antidepressants](https://en.wikipedia.org/wiki/List_of_antidepressants "List of antidepressants") 1. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-158)** Also known as "*cis*\-(1S,4S)". Out of all four possible enantiomers, *cis*\-(1R,4R) is also active on the serotonin transporter,[\[156\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-156) and *trans*\-(1R,4S) is an [SNDRI](https://en.wikipedia.org/wiki/SNDRI "SNDRI")[\[157\]](https://en.wikipedia.org/wiki/Sertraline#cite_note-157). 1. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Brand2015_1-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Brand2015_1-1) ["Sertraline international"](https://www.drugs.com/international/sertraline.html). *Drugs.com*. Retrieved 11 May 2015. 2. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Drugs.com_pregnancy_2-0)** ["Sertraline (Zoloft) Use During Pregnancy"](https://www.drugs.com/pregnancy/sertraline.html). *Drugs.com*. 4 May 2020. Retrieved 17 May 2020. 3. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Hub2001_3-0)** Hubbard JR, Martin PR (2001). [*Substance Abuse in the Mentally and Physically Disabled*](https://books.google.com/books?id=MY1kFYk98mQC&pg=PA26). CRC Press. p. 26. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-8247-4497-7](https://en.wikipedia.org/wiki/Special:BookSources/978-0-8247-4497-7 "Special:BookSources/978-0-8247-4497-7") . 4. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-4)** [Anvisa](https://en.wikipedia.org/wiki/Brazilian_Health_Regulatory_Agency "Brazilian Health Regulatory Agency") (31 March 2023). ["RDC NÂș 784 - Listas de SubstĂąncias Entorpecentes, PsicotrĂłpicas, Precursoras e Outras sob Controle Especial"](https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-784-de-31-de-marco-de-2023-474904992) \[Collegiate Board Resolution No. 784 - Lists of Narcotic, Psychotropic, Precursor, and Other Substances under Special Control\] (in Brazilian Portuguese). [DiĂĄrio Oficial da UniĂŁo](https://en.wikipedia.org/wiki/Di%C3%A1rio_Oficial_da_Uni%C3%A3o "DiĂĄrio Oficial da UniĂŁo") (published 4 April 2023). [Archived](https://web.archive.org/web/20230803143925/https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-784-de-31-de-marco-de-2023-474904992) from the original on 3 August 2023. Retrieved 16 August 2023. 5. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-1) [***c***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-2) [***d***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-3) [***e***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-4) [***f***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-5) [***g***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-6) [***h***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-7) [***i***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-8) [***j***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-9) [***k***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-10) [***l***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-11) [***m***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-12) [***n***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-13) [***o***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-14) [***p***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-15) [***q***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-16) [***r***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-17) [***s***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-18) [***t***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-19) [***u***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-20) [***v***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-FDALabel_5-21) [Sertraline FDA Label](https://web.archive.org/web/20160625120717/http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/019839s084,020990s043lbl.pdf) Last updated May 2014 6. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-GG_6-0)** Brunton L, Chabner B, Knollman B (2010). *Goodman and Gilman's The Pharmacological Basis of Therapeutics* (Twelfth ed.). McGraw Hill Professional. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-07-176939-6](https://en.wikipedia.org/wiki/Special:BookSources/978-0-07-176939-6 "Special:BookSources/978-0-07-176939-6") . 7. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid16192315_7-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid16192315_7-1) [***c***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid16192315_7-2) Obach RS, Walsky RL, Venkatakrishnan K, Gaman EA, Houston JB, Tremaine LM (January 2006). "The utility of in vitro cytochrome P450 inhibition data in the prediction of drug–drug interactions". *The Journal of Pharmacology and Experimental Therapeutics*. **316** (1): 336–48\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1124/jpet.105.093229](https://doi.org/10.1124%2Fjpet.105.093229). 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"Sertraline is metabolized by multiple cytochrome P450 enzymes, monoamine oxidases, and glucuronyl transferases in human: an in vitro study". *Drug Metabolism and Disposition*. **33** (2): 262–70\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1124/dmd.104.002428](https://doi.org/10.1124%2Fdmd.104.002428). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [15547048](https://pubmed.ncbi.nlm.nih.gov/15547048). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [7254643](https://api.semanticscholar.org/CorpusID:7254643). 10. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-AHFS2018_10-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-AHFS2018_10-1) ["Sertraline Hydrochloride"](https://www.drugs.com/monograph/sertraline-hydrochloride.html). *Drugs.com*. The American Society of Health-System Pharmacists. 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["A Systematic Review and Meta-Analysis Considering the Risk for Congenital Heart Defects of Antidepressant Classes and Individual Antidepressants"](https://unisa.alma.exlibrisgroup.com/view/delivery/61USOUTHAUS_INST/12212569530001831). *Drug Saf*. **44** (3): 291–312\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s40264-020-01027-x](https://doi.org/10.1007%2Fs40264-020-01027-x). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [0114-5916](https://search.worldcat.org/issn/0114-5916). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [33354752](https://pubmed.ncbi.nlm.nih.gov/33354752). 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[ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-3-319-50172-7](https://en.wikipedia.org/wiki/Special:BookSources/978-3-319-50172-7 "Special:BookSources/978-3-319-50172-7") . [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28315270](https://pubmed.ncbi.nlm.nih.gov/28315270). 138. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid20373470_138-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid20373470_138-1) [***c***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid20373470_138-2) [***d***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid20373470_138-3) Hindmarch I, Hashimoto K (April 2010). "Cognition and depression: the effects of fluvoxamine, a sigma-1 receptor agonist, reconsidered". *Human Psychopharmacology*. **25** (3): 193–200\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1002/hup.1106](https://doi.org/10.1002%2Fhup.1106). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20373470](https://pubmed.ncbi.nlm.nih.gov/20373470). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [26491662](https://api.semanticscholar.org/CorpusID:26491662). 139. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-139)** Carhart-Harris RL, Nutt DJ (September 2017). ["Serotonin and brain function: a tale of two receptors"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5606297). *Journal of Psychopharmacology*. **31** (9): 1091–1120\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1177/0269881117725915](https://doi.org/10.1177%2F0269881117725915). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5606297](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5606297). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28858536](https://pubmed.ncbi.nlm.nih.gov/28858536). 140. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-140)** Harmer CJ, Duman RS, Cowen PJ (May 2017). ["How do antidepressants work? New perspectives for refining future treatment approaches"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410405). *The Lancet. Psychiatry*. **4** (5): 409–418\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S2215-0366(17)30015-9](https://doi.org/10.1016%2FS2215-0366%2817%2930015-9). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5410405](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410405). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28153641](https://pubmed.ncbi.nlm.nih.gov/28153641). 141. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid11357798_141-0)** Richelson E (May 2001). ["Pharmacology of antidepressants"](https://doi.org/10.4065%2F76.5.511). *Mayo Clinic Proceedings*. **76** (5): 511–27\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.4065/76.5.511](https://doi.org/10.4065%2F76.5.511). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [11357798](https://pubmed.ncbi.nlm.nih.gov/11357798). 142. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-HemmingsEgan2012_142-0)** Hemmings HC, Egan TD (2012). [*Pharmacology and Physiology for Anesthesia E-Book: Foundations and Clinical Application*](https://books.google.com/books?id=am_DS7rgypAC&pg=PA183). Elsevier Health Sciences. pp. 183–. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-1-4557-3793-2](https://en.wikipedia.org/wiki/Special:BookSources/978-1-4557-3793-2 "Special:BookSources/978-1-4557-3793-2") . 143. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid20021354_143-0)** Hashimoto K (September 2009). "Sigma-1 receptors and selective serotonin reuptake inhibitors: clinical implications of their relationship". *Central Nervous System Agents in Medicinal Chemistry*. **9** (3): 197–204\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.2174/1871524910909030197](https://doi.org/10.2174%2F1871524910909030197). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20021354](https://pubmed.ncbi.nlm.nih.gov/20021354). 144. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-144)** Chen-Ju Lin, Francis Robert, Rami Sukarieh, Stephen Michnick, Jerry Pelletier (15 April 2010). "The antidepressant sertraline inhibits translation initiation by curtailing mammalian target of rapamycin signaling". *Cancer Res*. **70** (8): 3199–208\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1158/0008-5472.CAN-09-4072](https://doi.org/10.1158%2F0008-5472.CAN-09-4072). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20354178](https://pubmed.ncbi.nlm.nih.gov/20354178). `{{cite journal}}`: CS1 maint: multiple names: authors list ([link](https://en.wikipedia.org/wiki/Category:CS1_maint:_multiple_names:_authors_list "Category:CS1 maint: multiple names: authors list")) 145. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-145)** Hui-Yun Hwang, Joong Sup Shim, Dasol Kim, Ho Jeong Kwon (October 2021). 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[doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s11064-025-04404-z](https://doi.org/10.1007%2Fs11064-025-04404-z). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [40278973](https://pubmed.ncbi.nlm.nih.gov/40278973). `{{cite journal}}`: CS1 maint: multiple names: authors list ([link](https://en.wikipedia.org/wiki/Category:CS1_maint:_multiple_names:_authors_list "Category:CS1 maint: multiple names: authors list")) 148. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-In_Vivo_SERT_binding_148-0)** Sprouse J, Clarke T, Reynolds L, Heym J, Rollema H (April 1996). ["Comparison of the effects of sertraline and its metabolite desmethylsertraline on blockade of central 5-HT reuptake in vivo"](https://doi.org/10.1016%2F0893-133X%2895%2900112-Q). *Neuropsychopharmacology*. **14** (4): 225–231\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/0893-133X(95)00112-Q](https://doi.org/10.1016%2F0893-133X%2895%2900112-Q). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [8924190](https://pubmed.ncbi.nlm.nih.gov/8924190). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [39841365](https://api.semanticscholar.org/CorpusID:39841365). 149. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid10383917_149-0)** Kobayashi K, Ishizuka T, Shimada N, Yoshimura Y, Kamijima K, Chiba K (July 1999). "Sertraline N-demethylation is catalyzed by multiple isoforms of human cytochrome P-450 in vitro". *Drug Metabolism and Disposition*. **27** (7): 763–6\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S0090-9556(24)15222-1](https://doi.org/10.1016%2FS0090-9556%2824%2915222-1). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [10383917](https://pubmed.ncbi.nlm.nih.gov/10383917). 150. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid29136336_150-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid29136336_150-1) [***c***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid29136336_150-2) Saiz-RodrĂ­guez M, Belmonte C, RomĂĄn M, Ochoa D, Koller D, TalegĂłn M, et al. (May 2018). ["Effect of Polymorphisms on the Pharmacokinetics, Pharmacodynamics and Safety of Sertraline in Healthy Volunteers"](https://doi.org/10.1111%2Fbcpt.12938). *Basic & Clinical Pharmacology & Toxicology*. **122** (5): 501–511\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1111/bcpt.12938](https://doi.org/10.1111%2Fbcpt.12938). [hdl](https://en.wikipedia.org/wiki/Hdl_\(identifier\) "Hdl (identifier)"):[10261/177557](https://hdl.handle.net/10261%2F177557). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [29136336](https://pubmed.ncbi.nlm.nih.gov/29136336). 151. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid31649299_151-0)** BrĂ„ten LS, Haslemo T, Jukic MM, Ingelman-Sundberg M, Molden E, Kringen MK (February 2020). ["Impact of CYP2C19 genotype on sertraline exposure in 1200 Scandinavian patients"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6969041). *Neuropsychopharmacology*. **45** (3): 570–576\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1038/s41386-019-0554-x](https://doi.org/10.1038%2Fs41386-019-0554-x). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6969041](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6969041). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [31649299](https://pubmed.ncbi.nlm.nih.gov/31649299). 152. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid33237321_152-0)** Milosavljevic F, Bukvic N, Pavlovic Z, Miljevic C, PeĆĄic V, Molden E, et al. (November 2020). ["Association of CYP2C19 and CYP2D6 Poor and Intermediate Metabolizer Status With Antidepressant and Antipsychotic Exposure: A Systematic Review and Meta-analysis"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7702196). *JAMA Psychiatry*. **78** (3): 270–280\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1001/jamapsychiatry.2020.3643](https://doi.org/10.1001%2Fjamapsychiatry.2020.3643). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [7702196](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7702196). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [33237321](https://pubmed.ncbi.nlm.nih.gov/33237321). 153. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Kachhadiya_2025_153-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Kachhadiya_2025_153-1) Kachhadiya RN, Shah BM (2025). ["Shaping the future of medicine through diverse therapeutic applications of tetralin derivatives"](https://www.researchgate.net/publication/385559544). *Medicinal Chemistry Research*. **34** (1): 86–113\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s00044-024-03331-y](https://doi.org/10.1007%2Fs00044-024-03331-y). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [1054-2523](https://search.worldcat.org/issn/1054-2523). 154. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Welch_154-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Welch_154-1) Welch WM (1995). *Discovery and Development of Sertraline*. Advances in Medicinal Chemistry. Vol. 3. pp. 113–148\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/S1067-5698(06)80005-2](https://doi.org/10.1016%2FS1067-5698%2806%2980005-2). [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-1-55938-798-9](https://en.wikipedia.org/wiki/Special:BookSources/978-1-55938-798-9 "Special:BookSources/978-1-55938-798-9") . 155. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-155)** Sarges R, Tretter JR, Tenen SS, Weissman A (September 1973). "5,8-Disubstituted 1-aminotetralins. A class of compounds with a novel profile of central nervous system activity". *Journal of Medicinal Chemistry*. **16** (9): 1003–11\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1021/jm00267a010](https://doi.org/10.1021%2Fjm00267a010). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [4795663](https://pubmed.ncbi.nlm.nih.gov/4795663). 156. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-156)** Huddart R, Hicks JK, Ramsey LB, Strawn JR, Smith DM, Bobonis Babilonia M, et al. (February 2020). ["PharmGKB summary: sertraline pathway, pharmacokinetics"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008964). *Pharmacogenetics and Genomics*. **30** (2): 26–33\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1097/FPC.0000000000000392](https://doi.org/10.1097%2FFPC.0000000000000392). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [7008964](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008964). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [31851125](https://pubmed.ncbi.nlm.nih.gov/31851125). 157. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-157)** [U.S. patent 4,556,676](https://patents.google.com/patent/US4556676) 158. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-159)** See also: Mullin R (2006). ["ACS Award for Team Innovation"](https://doi.org/10.1021%2Fcen-v084n010.p045). *Chemical & Engineering News*. **84** (5): 45–52\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1021/cen-v084n010.p045](https://doi.org/10.1021%2Fcen-v084n010.p045). 159. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-160)** A short blurb on the history of sertraline, see: Couzin J (July 2005). "The brains behind blockbusters". *Science*. **309** (5735): 728. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1126/science.309.5735.728](https://doi.org/10.1126%2Fscience.309.5735.728). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [16051786](https://pubmed.ncbi.nlm.nih.gov/16051786). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [45532935](https://api.semanticscholar.org/CorpusID:45532935). 160. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-He168_161-0)** [Healy D](https://en.wikipedia.org/wiki/David_Healy_\(psychiatrist\) "David Healy (psychiatrist)") (1999). *The Antidepressant Era*. Cambridge, Massachusetts: Harvard University Press. p. 168. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-674-03958-2](https://en.wikipedia.org/wiki/Special:BookSources/978-0-674-03958-2 "Special:BookSources/978-0-674-03958-2") . 161. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pdac_162-0)** ["Minutes of the 33rd Meeting of Psychopharmacological Drugs Advisory Committee on November 19, 1990"](http://www.healyprozac.com/PDAC/PDAC-Zoloft%20Nov%2090.pdf) (PDF). FDA. 1990. Retrieved 11 July 2008. 162. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid8573661_163-0)** See also: Fabre LF, Abuzzahab FS, Amin M, Claghorn JL, Mendels J, Petrie WM, et al. (November 1995). "Sertraline safety and efficacy in major depression: a double-blind fixed-dose comparison with placebo". *Biological Psychiatry*. **38** (9): 592–602\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/0006-3223(95)00178-8](https://doi.org/10.1016%2F0006-3223%2895%2900178-8). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [8573661](https://pubmed.ncbi.nlm.nih.gov/8573661). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [27253073](https://api.semanticscholar.org/CorpusID:27253073). 163. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-164)** ["Safety review of antidepressants used by children completed"](https://web.archive.org/web/20080616231154/http://www.mhra.gov.uk/NewsCentre/Pressreleases/CON002045). [MHRA](https://en.wikipedia.org/wiki/Medicines_and_Healthcare_products_Regulatory_Agency "Medicines and Healthcare products Regulatory Agency"). 10 December 2003. Archived from [the original](http://www.mhra.gov.uk/NewsCentre/Pressreleases/CON002045) on 16 June 2008. Retrieved 11 July 2008. 164. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-165)** Boseley S (10 December 2003). ["Drugs for depressed children banned"](https://www.theguardian.com/uk_news/story/0,3604,1103563,00.html). *[The Guardian](https://en.wikipedia.org/wiki/The_Guardian "The Guardian")*. Retrieved 19 April 2007. 165. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-166)** ["Overview of regulatory status and CSM advice relating to major depressive disorder in children and adolescents"](https://web.archive.org/web/20080802183642/http://www.mhra.gov.uk/Safetyinformation/Safetywarningsalertsandrecalls/Safetywarningsandmessagesformedicines/CON019494). MHRA. Archived from [the original](http://www.mhra.gov.uk/Safetyinformation/Safetywarningsalertsandrecalls/Safetywarningsandmessagesformedicines/CON019494) on 2 August 2008. Retrieved 17 April 2008. 166. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-167)** Food and Drug Administration (2 May 2007). ["FDA Proposes New Warnings About Suicidal Thinking, Behavior in Young Adults Who Take Antidepressant Medications"](https://web.archive.org/web/20070505020340/http://www.fda.gov/bbs/topics/NEWS/2007/NEW01624.html). *[Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration")*. Archived from [the original](https://www.fda.gov/bbs/topics/NEWS/2007/NEW01624.html) on 5 May 2007. Retrieved 11 July 2008. 167. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-168)** Smith A (17 July 2006). ["Pfizer needs more drugs"](https://money.cnn.com/2006/07/17/news/companies/pfizer/index.htm). CNN. Retrieved 27 January 2007. 168. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-169)** ["Pfizer Completes Transaction to Combine Its Upjohn Business with Mylan"](https://www.businesswire.com/news/home/20201116005378/en/). Pfizer. 16 November 2020. Retrieved 17 June 2024 – via Business Wire. 169. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-170)** ["Zoloft"](https://www.pfizer.com/products/product-detail/zoloft). *Pfizer*. Retrieved 17 June 2024. 170. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-171)** ["Brands"](https://www.viatris.com/en/products/brands). *Viatris*. 16 November 2020. Retrieved 17 June 2024. 171. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-pmid37731683_172-0)** Erdoğan Kaya A, Oğur NB (September 2023). ["The Impact of the COVID-19 Pandemic on the Interest in Antidepressants: An Analysis of Worldwide Internet Searches With Google Trends Data"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10508353). *Cureus*. **15** (9) e45558. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.7759/cureus.45558](https://doi.org/10.7759%2Fcureus.45558). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [10508353](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10508353). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [37731683](https://pubmed.ncbi.nlm.nih.gov/37731683). 172. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Ebola-treatment_173-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Ebola-treatment_173-1) - ‱ Cardile AP, Warren TK, Martins KA, Reisler RB, Bavari S (January 2017). ["Will There Be a Cure for Ebola?"](https://doi.org/10.1146%2Fannurev-pharmtox-010716-105055). *Annual Review of Pharmacology and Toxicology*. **57** (1). [Annual Reviews](https://en.wikipedia.org/wiki/Annual_Reviews_\(publisher\) "Annual Reviews (publisher)"): 329–348\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1146/annurev-pharmtox-010716-105055](https://doi.org/10.1146%2Fannurev-pharmtox-010716-105055). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [27959624](https://pubmed.ncbi.nlm.nih.gov/27959624). - ‱ Johansen LM, DeWald LE, Shoemaker CJ, Hoffstrom BG, Lear-Rooney CM, Stossel A, et al. (June 2015). ["A screen of approved drugs and molecular probes identifies therapeutics with anti-Ebola virus activity"](https://doi.org/10.1126%2Fscitranslmed.aaa5597). *[Science Translational Medicine](https://en.wikipedia.org/wiki/Science_Translational_Medicine "Science Translational Medicine")*. **7** (290). [American Association for the Advancement of Science](https://en.wikipedia.org/wiki/American_Association_for_the_Advancement_of_Science "American Association for the Advancement of Science") (AAAS): 290ra89. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1126/scitranslmed.aaa5597](https://doi.org/10.1126%2Fscitranslmed.aaa5597). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [26041706](https://pubmed.ncbi.nlm.nih.gov/26041706). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [88805622](https://api.semanticscholar.org/CorpusID:88805622). 173. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Phospholipase-B_174-0)** - ‱ Lass-Flörl C, Ledochowski M, Fuchs D, Speth C, Kacani L, Dierich MP, et al. (January 2003). ["Interaction of sertraline with Candida species selectively attenuates fungal virulence in vitro"](https://doi.org/10.1111%2Fj.1574-695x.2003.tb00643.x). *FEMS Immunology and Medical Microbiology*. **35** (1). [Oxford University Press](https://en.wikipedia.org/wiki/Oxford_University_Press "Oxford University Press") ([Federation of European Microbiological Societies](https://en.wikipedia.org/wiki/Federation_of_European_Microbiological_Societies "Federation of European Microbiological Societies")): 11–15\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1111/j.1574-695x.2003.tb00643.x](https://doi.org/10.1111%2Fj.1574-695x.2003.tb00643.x). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [12589952](https://pubmed.ncbi.nlm.nih.gov/12589952). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [11240443](https://api.semanticscholar.org/CorpusID:11240443). - ‱ Schaller M, Borelli C, Korting HC, Hube B (November 2005). "Hydrolytic enzymes as virulence factors of *Candida albicans*". *[Mycoses](https://en.wikipedia.org/wiki/Mycoses_\(journal\) "Mycoses (journal)")*. **48** (6). [Blackwell Publishing](https://en.wikipedia.org/wiki/Blackwell_Publishing "Blackwell Publishing"): 365–377\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1111/j.1439-0507.2005.01165.x](https://doi.org/10.1111%2Fj.1439-0507.2005.01165.x). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [16262871](https://pubmed.ncbi.nlm.nih.gov/16262871). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [1356254](https://api.semanticscholar.org/CorpusID:1356254). - ‱ Lyte M, ed. (2016). *Microbial Endocrinology: Interkingdom Signaling in Infectious Disease and Health*. Advances in Experimental Medicine and Biology. Vol. 874. [Cham, Switzerland](https://en.wikipedia.org/wiki/Cham,_Switzerland "Cham, Switzerland"): Springer. pp. xiii+374. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/978-3-319-20215-0](https://doi.org/10.1007%2F978-3-319-20215-0). [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-3-319-20215-0](https://en.wikipedia.org/wiki/Special:BookSources/978-3-319-20215-0 "Special:BookSources/978-3-319-20215-0") . [OCLC](https://en.wikipedia.org/wiki/OCLC_\(identifier\) "OCLC (identifier)") [932167823](https://search.worldcat.org/oclc/932167823). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [7784624](https://api.semanticscholar.org/CorpusID:7784624). [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-3-319-20214-3](https://en.wikipedia.org/wiki/Special:BookSources/978-3-319-20214-3 "Special:BookSources/978-3-319-20214-3") . [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-3-319-79299-6](https://en.wikipedia.org/wiki/Special:BookSources/978-3-319-79299-6 "Special:BookSources/978-3-319-79299-6") . : 349, 355 - ‱ Cussotto S, Clarke G, Dinan TG, Cryan JF (May 2019). ["Psychotropics and the Microbiome: a Chamber of Secrets..."](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598948) *Psychopharmacology*. **236** (5). [Springer Science and Business Media](https://en.wikipedia.org/wiki/Springer_Science_and_Business_Media "Springer Science and Business Media") ([European Behavioural Pharmacology Society](https://en.wikipedia.org/w/index.php?title=European_Behavioural_Pharmacology_Society&action=edit&redlink=1 "European Behavioural Pharmacology Society (page does not exist)") (EBPS)): 1411–1432\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s00213-019-5185-8](https://doi.org/10.1007%2Fs00213-019-5185-8). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6598948](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598948). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [30806744](https://pubmed.ncbi.nlm.nih.gov/30806744). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [71145305](https://api.semanticscholar.org/CorpusID:71145305). 174. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Chamber-of-Secrets_175-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Chamber-of-Secrets_175-1) [***c***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Chamber-of-Secrets_175-2) Cussotto S, Clarke G, Dinan TG, Cryan JF (May 2019). ["Psychotropics and the Microbiome: a Chamber of Secrets..."](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598948) *Psychopharmacology*. **236** (5). [Springer Science and Business Media](https://en.wikipedia.org/wiki/Springer_Science_and_Business_Media "Springer Science and Business Media") ([European Behavioural Pharmacology Society](https://en.wikipedia.org/w/index.php?title=European_Behavioural_Pharmacology_Society&action=edit&redlink=1 "European Behavioural Pharmacology Society (page does not exist)") (EBPS)): 1411–1432\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s00213-019-5185-8](https://doi.org/10.1007%2Fs00213-019-5185-8). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6598948](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598948). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [30806744](https://pubmed.ncbi.nlm.nih.gov/30806744). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [71145305](https://api.semanticscholar.org/CorpusID:71145305). 175. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Photosensitizers_176-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Photosensitizers_176-1) [***c***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Photosensitizers_176-2) Maldonado-Carmona N, Ouk TS, Calvete MJ, Pereira MM, Villandier N, Leroy-Lhez S (April 2020). ["Conjugating biomaterials with photosensitizers: advances and perspectives for photodynamic antimicrobial chemotherapy"](https://doi.org/10.1039%2FC9PP00398C). Paper. *Photochemical & Photobiological Sciences*. **19** (4). [Royal Society of Chemistry](https://en.wikipedia.org/wiki/Royal_Society_of_Chemistry "Royal Society of Chemistry") (RSC): 445–461\. [Bibcode](https://en.wikipedia.org/wiki/Bibcode_\(identifier\) "Bibcode (identifier)"):[2020PhPhS..19..445M](https://ui.adsabs.harvard.edu/abs/2020PhPhS..19..445M). [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1039/C9PP00398C](https://doi.org/10.1039%2FC9PP00398C). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [32104827](https://pubmed.ncbi.nlm.nih.gov/32104827). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [211537822](https://api.semanticscholar.org/CorpusID:211537822). 176. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Immunomodulation_177-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-Immunomodulation_177-1) Arreola R, Becerril-Villanueva E, Cruz-Fuentes C, Velasco-VelĂĄzquez MA, GarcĂ©s-Alvarez ME, Hurtado-Alvarado G, et al. (2015). ["Immunomodulatory effects mediated by serotonin"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4417587). *Journal of Immunology Research*. **2015** 354957. [Hindawi Publishing Corporation](https://en.wikipedia.org/wiki/Hindawi_Publishing_Corporation "Hindawi Publishing Corporation"). [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1155/2015/354957](https://doi.org/10.1155%2F2015%2F354957). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [4417587](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4417587). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [25961058](https://pubmed.ncbi.nlm.nih.gov/25961058). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [17202427](https://api.semanticscholar.org/CorpusID:17202427). 354957. 177. ^ [***a***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-tcruz_178-0) [***b***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-tcruz_178-1) [***c***](https://en.wikipedia.org/wiki/Sertraline#cite_ref-tcruz_178-2) Hassanzadeh P, Atyabi F, Dinarvand R (2019). "The significance of artificial intelligence in drug delivery system design". *Advanced Drug Delivery Reviews*. 151–152\. [Elsevier BV](https://en.wikipedia.org/wiki/Elsevier_BV "Elsevier BV"): 169–190\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.addr.2019.05.001](https://doi.org/10.1016%2Fj.addr.2019.05.001). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [31071378](https://pubmed.ncbi.nlm.nih.gov/31071378). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [149445737](https://api.semanticscholar.org/CorpusID:149445737). This review cites this study: Ferreira DD, Mesquita JT, da Costa Silva TA, Romanelli MM, da Gama Jaen Batista D, da Silva CF, et al. (2018). ["Efficacy of sertraline against *Trypanosoma cruzi*: an in vitro and in silico study"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208092). *The Journal of Venomous Animals and Toxins Including Tropical Diseases*. **24** (1) 30. [Springer Science and Business Media LLC](https://en.wikipedia.org/wiki/Springer_Science_and_Business_Media_LLC "Springer Science and Business Media LLC"). [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1186/s40409-018-0165-8](https://doi.org/10.1186%2Fs40409-018-0165-8). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6208092](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208092). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [30450114](https://pubmed.ncbi.nlm.nih.gov/30450114). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [53114045](https://api.semanticscholar.org/CorpusID:53114045). CEVAP/UNESP - [Centro de Estudos de Venenos e Animais Peçonhentos](https://en.wikipedia.org/w/index.php?title=Centro_de_Estudos_de_Venenos_e_Animais_Pe%C3%A7onhentos&action=edit&redlink=1 "Centro de Estudos de Venenos e Animais Peçonhentos (page does not exist)") SĂŁo Paulo State University. 178. **[^](https://en.wikipedia.org/wiki/Sertraline#cite_ref-179)** "Sertraline". [*Drugs and Lactation Database (LactMed)*](http://www.ncbi.nlm.nih.gov/books/NBK501191/). Bethesda (MD): National Institute of Child Health and Human Development. May 2025. [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [30000250](https://pubmed.ncbi.nlm.nih.gov/30000250). Bookshelf ID: NBK501191. Retrieved 31 August 2025. [![Wikimedia Commons logo](https://upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/40px-Commons-logo.svg.png)](https://en.wikipedia.org/wiki/File:Commons-logo.svg) Wikimedia Commons has media related to [Sertraline](https://commons.wikimedia.org/wiki/Category:Sertraline "commons:Category:Sertraline").
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