Sertraline in Bipolar Depression: What To Know

The science doesn't support using Sertraline as monotherapy for bipolar depression. Photo by Adrian Frentescu at Pexels.com

Sertraline (Zoloft) in Bipolar Depression

This is article is a summary of currently available evidence and information about Sertraline (Zoloft) for bipolar depression. 

Sertraline is categorized as a selective serotonin reuptake inhibitor. It mainly works through blocking the reuptake of serotonin in the synapses of the nerve cells, thus allowing for an increased effect of serotonin on the brain.

Bipolar Disorder was formerly known as manic-depressive illness, is a mental health disorder where the individual suffers from an unusual change in moods. The mood can either be heightened (manic) or lowered (depressive) and it is accompanied by an extreme shift in energy an activity levels.

Note that the information in this article may not be considered as individual medical advice. Consult with a healthcare professional, such as a psychiatrist or physician, before beginning starting any new medications.

Evidence

• The Food & Drugs Administration (FDA) has not approved treatment with Sertraline for bipolar depression.

• Currently, there are only three FDA approved medications for treatments for acute bipolar depression. These are Quetiapine, Lurasidone and a combination drug with Olanzapine+Fluoxetine.

• There is ongoing debate and disagreement about the appropriate use and effectiveness of second generation antidepressants (such as Sertraline) in treating bipolar depression, much because of concerns about their potential to cause mood switch, i.e. triggering hypomanic or manic episodes. 

• While some research suggests that antidepressants may be effective in the short term when used in conjunction with mood stabilizers, the overall evidence for their effectiveness in treating bipolar depression is weak. Thus, Sertraline is not considered first-line treatment of bipolar depression.

• One research study looked at bipolar patients with current depressed mood who were taking second-generation antidepressants, with the purpose of studying the risk of mood switch into hypomania or mania. The study compared Sertraline, Bupropion and Venlafaxine with each other. In summary, there was a significantly increased risk of switches into (hypo)manic episodes for patients taking Venlafaxine compared to using Bupropion or Sertraline for bipolar patients with depressive episodes.

Treatment with Sertraline for Bipolar Depression

• Second-generation antidepressants, e.g. Sertraline, should not be used as monotherapy for bipolar depression. They are not considered being reliable treatments for bipolar depression because of the lack of evidence showing their effectiveness. Any treatment with these types of antidepressants in bipolar depression is considered experimental and must be closely monitored by a licensed psychiatrist.
  

•  Treatment should always be in combination with a mood stabilizer, such as Lithium or Valproic Acid, and even then Sertraline may not provide any additional benefit in treating bipolar depression.

• There are no special recommended dosages when using Sertraline for bipolar depression, therefore careful dosing and titrating of the medication is necessary. However, when using Sertraline for unipolar depression the dosage begins at 25-50 mg daily. 

Potential Side Effects

• Common side effects of Sertraline include dizziness, nausea, loss of appetite, dry mouth, diarrhea, insomnia, excessive sweating, and emotional blunting.

• Triggering of hypomanic or manic episodes is the most worrying potential side effect of using Sertraline for bipolar depression. 

• Sertraline may cause sexual dysfunction, including difficulties reaching orgasm or ejaculation, decreased sexual desire, and erectile dysfunction.

• In rare cases, Sertraline may cause severe side effects such as severe weight-loss, increased risk of bleeding, seizures, and serious allergic reactions.

• The FDA has issued a black box warning for Sertraline due to the increased risk of suicidal thoughts and behaviors in children and teenagers taking the medication.

Contraindications

• Current hypomanic or manic episode. Caution should also be taken in patients with bipolar depression who has a history of rapid mood cycling.

• Moderate to severe liver problems.

• Allergy to Sertraline or any other selective serotonin reuptake inhibitor.

• Having taken an MAOI drug in the past 2 weeks, due to the risk of serotonin syndrome.

Useful Information

• Common side effects such as nausea, gastrointestinal problems and insomnia usually resolve by themselves within the first few weeks of taking the Sertraline.
  
  

Author: J. Martin, M.D. 
Last updated: August 26, 2023

Disclaimer: The information provided is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider, such as a physician, before starting any new treatment or making changes to your existing treatment plan. Individual responses to treatment may vary, and a healthcare professional can provide personalized guidance based on your specific needs and circumstances. If you are experiencing severe or persistent symptoms of disease seek immediate medical attention.