All you need to know about the antidepressant and its impact on your mental health.
By Dr Nick Knight, GQ
The unvarnished truth is already known, poor mental health in the UK is on the rise. And with one in four of us affected yearly, it’s no surprise that the rise of medications, like sertraline, are at an all-time prescribing high. Between 2017 and 2018, 7.3 million UK adults were prescribed an antidepressant, a popular choice being sertraline. That’s around eleven per cent of the population. This alone has sent the alarm bells ringing, triggering a wave of action from social media campaigns, and the introduction of work mental health first aiders, through to NHS initiatives to improve access to mental health services. But how does sertraline fit into all this and what is it actually doing to us?
The unvarnished truth is already known, poor mental health in the UK is on the rise. And with one in four of us affected yearly, it’s no surprise that the rise of medications, like sertraline, are at an all-time prescribing high. Between 2017 and 2018, 7.3 million UK adults were prescribed an antidepressant, a popular choice being sertraline. That’s around eleven per cent of the population. This alone has sent the alarm bells ringing, triggering a wave of action from social media campaigns, and the introduction of work mental health first aiders, through to NHS initiatives to improve access to mental health services. But how does sertraline fit into all this and what is it actually doing to us?
How does sertraline work?
Sertraline increases serotonin, a potent neurotransmitter, in your brain. With higher levels of serotonin is thought to come feelings of wellbeing and happiness. It does this by its action as a selective serotonin re-uptake inhibitor (SSRI). As an SSRI, it blocks the uptake of serotonin into cells, thereby leaving the extracellular levels higher, which, we suspect, boosts a positive mood.
What is sertraline used for?
Given its potential to boost your mood, sertraline has found itself as part of the management for conditions including moderate to severe depression, panic attacks, generalised anxiety disorder and obsessive compulsive disorder. One lesser-known role for this SSRI also includes the management of premature ejaculation, but more on that later.
How do you take sertraline?
It’s pretty simple. If you come and see me at my GP surgery, I explain that the starting dose is 50mg a day in adults. That’s one tablet a day. We then up-titrate (or down-titrate if you have side effects, for example) the dose in 50mg increments over weeks or months depending on how you respond. The maximum is 200mg in a day. Courses can last from six months to a lifetime for some.
Is sertraline the same as other SSRIs?
Given the rates of mental health, coupled with our prolific media coverage, you probably know someone who is on an SSRI. In the UK, the commonest include citalopram, fluoxetine (Prozac), paroxetine (Seroxat) and sertraline. Sertraline tends to be the first line drug therapy for a number of mental health conditions over other SSRIs due to less side effects. Though with that said, some people naturally get on better with others.
How long does sertraline take to work?
Whenever I start someone on a drug like sertraline, the message is always the same – have patience. Sertraline isn’t like the short and rapid acting benzodiazepine, Xanax, that we discussed recently. It has a slow and purposeful burn. In fact, for the first two weeks, you may find your depression or anxiety actually worsens (a paradoxical response you don’t expect – so need to be warned about), before the drug then starts to have more positive effects, which peak at around six weeks of use. Along this journey, the drug dose is adjusted based on the response and any side effects experienced.
What are sertraline’s side effects?
It’s going to vary between all of you. The common ones, diarrhoea, sleep disturbance, sexual dysfunction (lower libido, erectile dysfunction) may often appear in the first few weeks before then subsiding. One I have seen a lot of recently is teeth grinding in sleep but once again, these all seem to settle. Now you may have noticed that I mentioned earlier that sertraline is used for premature ejaculation – but now I’m saying it can cause sexual dysfunction. It’s true there is a conflict here. Overall, the drug helps improve your mood and mental wellbeing. This in turns feeds positively into your libido and sexual function and confidence. Ultimately the benefit often outweighs the risk.
Can I get addicted to sertraline?
Not really, no. It’s not uncommon, however for people to develop a psychological dependency. By this I mean, there’s this sense that by stopping the drug, their mental health will suffer. Truth is there’s no way of knowing. I’ve seen people come off it and maintain good mental health, while others see an immediate decline. It’s those latter cases that show sertraline’s benefit and the need for some to remain on it for longer.
What if I want to stop sertraline?
If you’re in the headspace for stopping, then it’s time to see your doctor. The dose of sertraline needs to be slowly reduced over weeks, monitoring how your mental health responds to this along the way. If you stop cold turkey you may experience symptoms of dizziness, nausea, rebound anxiety and depression, as well as flu-like symptoms. Let your doctor guide you through this period.
Don’t forget the big picture...
No drug is an island. Sertraline is no different. And that, is the big picture. Mental health is not cured alone with one drug. In fact, the drug is to compliment all other forms of equally important treatments – lifestyle changes and optimisation, including physical activity; talking therapy (CBT or psychotherapy) in groups, one to one, or with your family; support from mental health teams and last but not least, education on the condition itself. Sertraline has its place. Just not on a pedestal.
