Numerous studies have shown that the clinical antidepressant sertraline (Zoloft) is biologically active in model systems, including fungi, which do not express its putative protein target, the serotonin/5-HT transporter, thus demonstrating the existence of one or more secondary targets. Here we show that in the absence of its putative protein target, sertraline targets phospholipid membranes that comprise the acidic organelles of the intracellular vesicle transport system by a mechanism consistent with the bilayer couple hypothesis. On the basis of a combination of drug-resistance selection and chemical-genomic screening, we hypothesize that loss of vacuolar ATPase activity reduces uptake of sertraline into cells, whereas dysregulation of clathrin function reduces the affinity of membranes for sertraline. Remarkably, sublethal doses of sertraline stimulate growth of mutants with impaired clathrin function. Ultrastructural studies of sertraline-treated cells revealed a phenotype that resembles phospholipidosis induced by cationic amphiphilic drugs in mammalian cells. Using reconstituted enzyme assays, we also demonstrated that sertraline inhibits phospholipase A 1 and phospholipase D, exhibits mixed effects on phospholipase C, and activates phospholipase A 2 . Overall, our study identifies two evolutionarily conserved membrane-active processes-vacuolar acidification and clathrin-coat formation-as modulators of sertraline's action at membranes. S ERTRALINE, whose trade name is Zoloft, is a Food and Drug Administration (FDA) approved drug that belongs to the pharmacological class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) (Koe et al. 1983). The putative therapeutic target of SSRIs is the human serotonin/5-HT transporter (hSERT/5-HTT/SLC6A4), an integral membrane protein that mediates sodium-dependent reuptake of the monoamine neurotransmitter serotonin at presynaptic nerve terminals in the brain (Tatsumi et al. 1997;Mortensen et al. 2001;Meyer et al. 2004). Indeed, the recent crystal structure of sertraline bound to a bacterial leucine transporter, LeuT-a homolog of mammalian monoamine transporters-has led to the proposal of a corresponding high-affinity binding site for sertraline in hSERT (Zhou et al. 2009). Inhibition of hSERT-dependent reuptake by sertraline is thought to underlie its antidepressant effect in people, as documented extensively over the last two decades in the clinical psychiatric literature (reviewed in Cipriani et al.
2009).However, there are numerous examples of sertraline's effects on cellular physiology, including, most curiously, cytotoxicity in yeast (Lass-Flö rl et al. 2001a,b), by an unknown mechanism that does not involve hSERT, suggesting the existence of one or more heretofore unrecognized secondary drug targets that may be evolutionarily conserved (Levkovitz et al. 2007;Reddy et al. 2008). Those observations, coupled with reports that antidepressants can accumulate in the brains of people to concentrations at which ''off-target'' effects are see...