Sertraline with Dehydroepiandrosterone Interaction Details
Brand Names Associated with Sertraline
- Sertraline
- Zoloft®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 08, 2023
Interaction Effect
Development of manic symptoms
Interaction Summary
A case has been reported in which concomitant dehydroepiandrosterone (DHEA) and sertraline use was suggested to precipitate a manic episode in a patient with a history of bipolar disorder. DHEA was also noted to cause mania in a patient with no previous personal or family history of bipolar disorder . Elevated DHEA levels have been found in patients with mental disorders; DHEA suppression has lead to improvement in psychotic symptoms . DHEA possesses proserotonergic activity which may predispose patients to manic episodes . DHEA is a precursor to androgenic steroids, which in high doses may precipitate mania . Patients taking medication for bipolar disorder or patients with a personal and/or family history of bipolar disorder should not take DHEA until further data is available to characterize this drug-herb interaction. Concomitant use of DHEA with selective serotonin reuptake inhibitors (SSRIs) should be avoided due to the potential additive precipitation of mania.
Severity
Moderate
Onset
Delayed
Evidence
Theoretical
How To Manage Interaction
Avoid concomitant use of dehydroepiandrosterone (DHEA) and selective serotonin reuptake inhibitors. If patients present with manic symptoms (i.e. agitation, anger, irritability, aggressive behavior), determine if the patient is using DHEA and discontinue DHEA.
Mechanism Of Interaction
Serotonergic activity of dehydroepiandrosterone, possibly increased androgen levels
Literature Reports
A) A 31-year-old male was admitted following threats to commit suicide and injure family members. He had self-initiated sertraline 100 milligrams (mg) daily for the previous 2 to 3 weeks for depression. Sertraline had been prescribed 3 years prior when he was diagnosed with bipolar disorder, which he discontinued after 2 weeks. He had also taken dehydroepiandrosterone (DHEA) 300 mg to 500 mg daily for the previous 2 months apparently for weight training. Following use of DHEA for a short time, he became more irritable, was not sleeping well, and began threatening a female friend and family members. He also drank alcohol occasionally and reportedly had difficulty controlling his anger when intoxicated. Sertraline was stopped and the patient was treated with valproic acid with the dose titrated to 500 mg twice daily. The combination of DHEA, sertraline, and alcohol was suggested responsible for the developing of the manic episode .
Sertraline Overview
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Sertraline is used to treat depression, obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over), panic attacks (sudden, unexpected attacks of extreme fear and worry about these attacks), posttraumatic stress disorder (disturbing psychological symptoms that develop after a frightening experience), and social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life). It is also used to relieve the symptoms of premenstrual dysphoric disorder, including mood swings, irritability, bloating, and breast tenderness. Sertraline is in a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amounts of serotonin, a natural substance in the brain that helps maintain mental balance.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
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Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.