Quote Originally Posted by Lady Penelope View Post
I have now taken 12.5mg for two nights and plan to continue for 7 before increasing to 25mg.
The rule of thumb on this is to not increase med doses sooner than 5 times their half-life which is the point at which plasma levels usually stabilise to a steady-state. For sertraline this is 26 hours x 5 = 130 h/5 days. I usually recommend folk take an extra days or two as a confidence booster so increasing the dose ever 7 days is ideal. Doing it sooner may increase the severity of side-effects, but delaying it won't significantly lower their severity no matter how long the delay.

what’s the deal with Sertraline and alcohol? I must admit to be drinking most days since lockdown -probably about half a bottle of wine every night but have not had any since I started Sertraline. Will I be ok to have a glass or two if wine or should I abstain completely?
Sorry to be literally a party pooper, but ADs and alcohol are not a good mix. Firstly, the AD+alcohol combination can be unpredictable. Some days you may be able to drink a herd of alcoholic elephants under the table without raising a sweat, on others a small glass of wine could turn legs to rubber. Plus, as WiseMonkey has already posted, alcohol may increase side-effects severity. Be extra cautious until you work out how the combination effects you.

The second issue is that alcohol can inhibit the mechanism by which ADs work. They stimulate the growth of new brain cells (neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels, mostly of cortisol (PDF). The therapeutic response is produced by these new cells and the stronger interconnections they forge, not the meds directly.

The problem is alcohol has the same effect on hippocampal neurogenesis as cortisol. Even moderate drinking can reduce cell growth by nearly half (see also: Morris SA, 2010; Crews FT, 2003). This, and a few other factors, is why alcohol has never proven to be a anxiety/depression cure despite probably being the most (self)prescribed 'med' for these disorders. They mostly create a tag team downward spiral to rock bottom.