Sertraline

• Depression in pregnancy
• Postnatal depression
• Anxiety disorders, OCD, PTSD in perinatal period

Selective serotonin reuptake inhibition at SERT → ↑ synaptic 5-HT.

• Relative infant dose <2% — first-choice SSRI in lactation
• Onset 4–6 weeks — warn about initial anxiety spike
• Wean to avoid discontinuation syndrome

Start

50 mg OD (25 mg if anxious presentation)

Titrate

Increase by 50 mg every 2–4 weeks; max 200 mg/day

• AbsoluteConcurrent MAOI (serotonin syndrome)
• CautionBleeding disorders, epilepsy

• Nausea, diarrhoea (first weeks)
• Sexual dysfunction
• Insomnia or somnolence
• Hyponatraemia (SIADH, elderly)

• • No teratogenic signal
• • Late 3rd trimester: neonatal adaptation syndrome (jittery, feeding difficulty) — do NOT stop, self-limits in <2 weeks
• • PPHN absolute risk <1%

• Tramadol / pethidine / linezolid

  Avoid

  Serotonin syndrome

• NSAIDs / aspirin

  Caution

  ↑ GI bleed risk

• Warfarin

  Caution

  ↑ INR, bleeding

• 💡 Do not stop untreated depression in pregnancy — untreated illness carries greater fetal risk
• 💡 Talking therapy always offered alongside medication