Does sertraline need a prescription? (+3 Contraindications)

In this article, we will discuss whether sertraline needs to be prescribed. We also will explore how the drug is prescribed, the possible indications, medication benefits, contraindications and precautions when prescribing this medication.

Does sertraline need a prescription?

Yes. Sertraline needs to be prescribed by a licensed healthcare provider. The health practitioner has to prescribe the dosage strength, frequency and timeframe. It is a prescription-only medication that is used in the treatment of depression and anxiety.

Sertraline is a selective serotonin reuptake inhibitor (SSRIs) that is used in the treatment of major depression, panic disorder, Obsessive-compulsive disorder (OCD), and social anxiety disorder (1). It works by increasing the level of serotonin in the brain. Serotonin neurotransmitter needs to stay in the synapse for some time to allow proper signalling. People with depression have also been associated with low serotonin activity in the brain (2).

Sertraline therefore works by inhibiting the reuptake of serotonin in the synapse thus prolonging its activity in the brain. The overall results of a decreased serotonin reuptake are mood elevation and the diminishing of symptoms associated with depression, anxiety and OCD. Sertraline has also been shown to possess more dopaminergic activity than other  SSRIs (3).

Why does sertraline need a prescription?

Sertraline needs a prescription because treatment duration and dosages vary with the severity and type of illness. Before getting sertraline, a diagnosis has to first be made to determine the nature of the illness. The diagnosing health professional communicates with the prescriber who writes a prescription based on the nature of the illness and the recommended treatment guidelines.

The prescription should contain the name of the medication, strength, dosage form, dosage frequency and dosage duration. It should also contain additional requirements like the name of the prescriber, their address, the patient’s biodata, and the date to make it legal. The prescription communicates to the dispensing personnel the nature of the illness so that they may advise the patient on proper medication use depending on the disease. Medicines that do not require a prescription are those that are used to treat self-diagnosable conditions like allergies and pain.

What are the common uses and indications for sertraline?

Sertraline is commonly used in the treatment of the following FDA-approved indications (4):

• Major depressive disorder (It is the first line drug in the treatment of major depression)
• Social anxiety disorder
• Panic disorder
• Obsessive-compulsive disorder
• Post-traumatic stress disorder
• Premenstrual dysphoric disorder

It can also be used in the treatment of the following non-FDA-approved indications (4):

• Binge eating disorders
• Bulimia nervosa
• Body dysmorphic disorder
• Generalized anxiety disorder
• Premature release

Sertraline is given orally once daily in the morning or evening. The absorption of this medication improves with the presence of food in the gastrointestinal tract (GIT). It is available in 25mg, 50mg, 100mg, 150mg and 20mg/ml dosage strengths. The prescription of any dosage strength depends on the disease and its severity.

Are there other possible contraindications for sertraline?

a. Contraindication #1: Allergic reactions and sensitivities

Sertraline is contraindicated in patients who are allergic to the medication or its metabolites. It is also prohibited to coadminister sertraline with Monoamine oxidase inhibitors, thioridazine, and pimozide (4). Patients who are taking other serotoninergic medications should also receive proper advice on the risks of coadministration. Sertraline should not be used until two weeks after using monoamine oxidase inhibitors has elapsed.

b. Contraindication #2: Disulfiram

Liquid formulations of sertraline are also contraindicated with disulfiram, an anti-alcoholism medication. Liquid concentrates of sertraline contain about 12% alcohol which reacts with disulfiram to induce disulfiram reaction. The reaction is characterized by symptoms that include flushing on the face, nausea, tachycardia, angioedema and hypotension.

c. Paediatrics

Sertraline is also contraindicated in paediatric patients. It should also be used with caution in people below 24 years. This medication has been shown to increase the risk of suicidal ideations in this population.

What is the success rate of sertraline?

Over the years, sertraline has proven to be successful in treating many psychotic disorders (4).  It has been tested and proven to be efficacious in randomized controled studies on patients with obsessive-compulsive disorder (OCD), panic disorder, social phobia, mood, anxiety and premenstrual disorder (4).

In one of the latest research on the medication, 152 advanced cancer patients were treated with sertraline for anxiety and depression. A success rate of 72.6% was noted after seven days of treatment. This study illustrates the efficacy of sertraline in managing depression and anxiety even in the event of chemotherapy (5).

What are the benefits of proper diagnosis and prescription?

A proper diagnosis is required before generating a prescription with sertraline because first, it allows for targeted treatment where medication is used to address a specific mental health condition. It also offers immediate symptom relief which enhances overall well-being. By addressing the underlying mental health condition accurately, the ability of a person to perform routine activities also improves.

Individuals need to communicate openly with their healthcare provider about any adverse effects and attend follow-up appointments to optimize the benefits of sertraline therapy.

What are some considerations and precautions for prescribing sertraline?

Special considerations should be given when prescribing sertraline to special populations which include; pregnant women, breastfeeding women, patients with liver impairment and patients with renal disease. Sertraline is classified as a category C medication for pregnant women (4). It is the preferred antidepressant in breastfeeding women. dosage adjustments are required in patients with hepatic and renal impairment.

The prescriber should also caution the patient against stopping the drug abruptly as it increases the risk of rebound adverse effects. They should instead taper the medication gradually before stopping whenever possible.

What are the dangers of acquiring sertraline without a prescription?

Acquiring sertraline without a prescription may be difficult considering most licensed pharmacists wouldn’t risk legal consequences of dispensing the medication without a prescription. However, In case you acquire and use sertraline without a prescription, you risk taking the wrong dosage which leads to ineffective treatment and an increased risk of side effects. There is also the risk of misdiagnosis, adverse reactions with other medications, worsening of symptoms, withdrawal symptoms, and delays in proper treatment.

Sertraline should therefore be acquired only using a prescription as this protects the patient, prescriber and the dispensing personnel.

In this article, we have discussed whether sertraline should be prescribed. Sertraline is used in the treatment of major depression, OCD, panic disorder, PTSD, SAD, and premenstrual dysphoric disorder. Other off-label indications where the medication may be prescribed include; eating disorders, GAD, body dysmorphic disorders and premature release. The medication should only be used after obtaining a legal prescription from persons mandated by law to prescribe. This medication has been contraindicated in people with hypersensitivity, paediatric, young adults and people using medications like those using MAOIs, thioridazine, pimozide and disulfiram. 

I strongly advocate for this because it protects both the patient and the prescriber. A prescription will ensure that you use the correct dosage and at the right frequency to manage specific symptoms. This will save on treatment costs, minimize the risk of toxicity and minimize time wastage during treatment. 

References