Sertraline is an SSRI class (selective serotonin reuptake inhibitor) antidepressant that’s approved by the U.S. FDA and available on prescription to treat a range of mental disorders. It’s been used for treating clinical depression and other conditions since 1991 and at first was marketed by Pfizer as Zoloft. Today, generic versions are widely available, but Zoloft remains the most well-known trade name. Sertraline is taken orally and comes in capsule sizes of 25mg to 100mg. A typical daily dose when used as antidepressant is 50mg.
Currently, sertraline in the U.S. market is FDA approved to treat the following conditions:
Aside from this list, doctors also prescribe sertraline for off-label purposes, such as treating sleep disorders, postpartum depression, and premature ejaculation. When taken to treat premature ejaculation, sertraline typically is prescribed as a low dosage and need-based medication. This means you only take it several hours prior to sexual activity.
In 2017, some 37.1 million sertraline prescription were issued in the United States alone, making the antidepressant one of the top 50 prescribed drugs in the country.
Sertraline, like all other SSRI (Prozac, Paxil, etc.), increases the brain’s serotonin levels. Serotonin, which also is known as the “happiness hormone”, is a neurotransmitter that — among a lot of other functions in the body — sends information back and forth between nerve cells in the brain. Brain serotonin levels are associated with feelings of happiness and general mental wellbeing; with low levels correlating with depression and other psychological problems.
Once a unit of serotonin is done with transmitting information to a brain nerve cell, it will be reabsorbed, i.e., converted into other chemicals. SSRI block this reabsorption, hence they are named “inhibitors”. By blocking reabsorption, serotonin levels in the brain begin rising, which is the process that, as doctors hope, eventually will lift people out of depression or ease anxiety disorder and improve mental wellbeing in general.
Sertraline’s use for delaying ejaculation, i.e., making men who have premature ejaculation issues last longer during sex, in fact is an originally unintended side effect of the drug. Sertraline can lower sexual appetite and sensitivity, which can be a problem for men who don’t have troubles with coming too early. But if you do ejaculate too quickly, sertraline’s dampening effect on your libido can make you last 5-6 minutes or longer instead of only 30 seconds, as several studies have shown.
When used as an antidepressant, it will take several months for sertraline to yield measurable improvements in mental wellbeing. Not only do serotonin levels need to be built up, but it takes time for the serotonin to alter emotional processing in the brain. A large British study done in 2015-2017 on 655 patients found that a noticeable improvement of depression symptoms became apparent (compared to a control group) only after 12 weeks of treatment. Earlier studies came to similar conclusions.
That’s why it often takes a couple of years for sertraline to fully heal major depression. Even after the patient no longer has any depression symptoms, many doctors continue prescribing sertraline for another 6-12 months in order to avoid a relapse.
Sertraline works a bit faster for anxiety disorder; usually the first improvements show up after six weeks of treatment, with the patient becoming calmer and les worried. Since often depression and anxiety go hand-in-hand, sertraline’s early effect on anxiety symptoms also benefits the treatment of depression in the longer run.
When taking sertraline to treat premature ejaculation, the effect of the drug is much more immediate. Usually it’s a matter of a few hours. Therefore, it’s recommended to take 50-100mg of sertraline 4 to 8 hours prior to sexual activity. That’s enough time for the drug to unfold its whole potential and maximize the delaying effect on ejaculation.
Sertraline is a powerful chemical and thus has a broad range of potential side effects. Fortunately, serious side effects are rare, and even the mild side effects usually are limited to the first 3-4 weeks of the treatment. Once sertraline has reached a stable level in your body and brain, these side effects tend to disappear. To be clear: this refers to sertraline’s use as antidepressant, where a daily dose is taken for months or years.
If you only take sertraline occasionally prior to sex —for example 5-8 single doses a month — to prevent premature ejaculation, the risk and intensity of side effects is much reduced. However, it’s important to be aware of what major side effects can be and how to notice them. Here’s a list of the most common side effects:
Sexual side effects: Some 40-65 percent of sertraline users experience a lower libido or orgasm difficulties during the initial weeks of sertraline treatment. Both men and women can be affected by this. These effects wear off with time as your body accustoms to the sertraline.
Dizziness: During the first several weeks on sertraline you may frequently feel a mild dizziness or lightheadedness. This is more common for people who take sertraline in the morning hours. Try switching your daily dose to the evening instead. For most people this improves the daytime dizziness.
Sleep problems: Like all SSRI, sertraline can affect the quality of your night sleep. You may find it harder to fall asleep or suddenly wake up at night. Once again, this is a short-term effect of sertraline and will eventually go away. Avoid coffee, energy drinks, and caffeinated sodas during the first month of taking sertraline, as this could exacerbate the sleeping problems.
Diarrhea: During the initial weeks of using sertraline, diarrhea and other gastrointestinal issues can be a common side effect. Studies show that some 15 percent of users experience diarrhea or milder bowel irritations.
All the above discussed side effects normally are only observed during the first month of sertraline treatment. If you notice no improvement by the second month of treatment, ask your doctor for help. He or she may be able to switch you to another SSRI or prescribe medication that alleviate the side effects.
Also seek immediate medical assistance if you start having suicidal thoughts or feel aggressive. Such thoughts and feelings can be a rare side effect of sertraline. It’s mostly only seen in people aged 24 or younger, but it’s a good precaution to be alert. During your first few weeks on sertraline or other SSRI, tell your doctor about any mood and behavior changes you yourself or your loved ones notice.
Don’t take sertraline when you are pregnant or thinking about becoming pregnant soon, as this increases the risk of miscarriage and other complications. However, studies indicate that sertraline can be used safely during breastfeeding.
To learn more about other potential side effects of sertraline not mentioned here, speak with a doctor or refer to the manufacturer’s package insert.
If you use sertraline infrequently for the purpose of delaying ejaculation, you want to take it 4-8 hours prior to having sex. Even shorter durations will yield positive results, but to maximize the effect try to give it at least four hours.
When using sertraline as an antidepressant treatment, most people take their daily dose either in the morning or evening. Which time you choose depends wholly on the side effects you experience during the initial treatment month. If taken in the morning, there’s a greater risk of daytime dizziness, and when taken in the evening it may reduce your sleep quality. At first, try the mornings for a week or two. If that doesn’t make you feel dizzy, continue with the morning dosing. Otherwise, switch to taking sertraline in the evening and see whether it affects your sleep. Ultimately, you have to opt for the time of the day that is likely to give you the least side effects. If in doubt, ask your doctor how to best take sertraline.
Sertraline isn’t available over the counter, as it’s a powerful substance and there’s risk of abuse. It can only be had on prescription by a licensed doctor. It’s usually in stock in all major pharmacies and readily available once you show the pharmacist your prescription.
Another, perhaps more convenient, way to get sertraline is through an internet pharmacy, which can save you time and money. Most legal online pharmacies have licenses allowing them to prescribe all sorts of prescription drugs. For this purpose they employ licensed doctors and/or pharmacists. Consultations often are free-of-charge. Check the website of the Board of Pharmacy in the state you live in to see whether an internet pharmacy is licensed to issue medical prescriptions.