SERTALINE

CNS Drugs 2002;16(11):789-94
Spotlight on sertraline (Zoloft) in the management of major depressive disorder in elderly patients
Muijsers RB, Plosker GL, Noble S
Adis International Limited, Auckland, New Zealand

Sertraline is a selective serotonin reuptake inhibitor (SSRI) with well established antidepressant and anxiolytic activity. Results from several well designed trials show that sertraline (50-200 mg/day) is effective in the treatment of major depressive disorder in elderly patients (>/=60 years of age). Primary endpoints in most studies included the Hamilton Depression Rating Scale (HDRS), Clinical Global Impression score and the Montgomery-Asberg Depression Rating Scale. Sertraline was significantly more effective than placebo and was as effective as fluoxetine, nortriptyline and imipramine in elderly patients. During one trial, amitriptyline was significantly more effective than sertraline (mean reduction from baseline on one of six primary outcomes [HDRS]), although no quantitative data were provided. Subgroup analysis of data from a randomised, double-blind trial in elderly patients with major depressive disorder suggests that vascular morbidity, diabetes mellitus or arthritis does not affect the antidepressant effect of sertraline. Secondary endpoints from these clinical trials suggest that sertraline has significant benefits over nortriptyline in terms of quality of life. In addition, significant differences favouring sertraline in comparison with nortriptyline and fluoxetine have been recorded for a number of cognitive functioning parameters. Sertraline is generally well tolerated in elderly patients with major depressive disorder and lacks the marked anticholinergic effects that characterise the adverse event profiles of tricyclic antidepressants (TCAs). The most frequently reported adverse events in patients aged >/=60 years with major depressive disorder receiving sertraline 50-150 mg/day were dry mouth, headache, diarrhoea, nausea, insomnia, somnolence, constipation, dizziness, sweating and taste abnormalities. The tolerability profile of sertraline is generally similar in younger and elderly patients. Sertraline has a low potential for drug interactions at the level of the cytochrome P450 enzyme system. In addition, no dosage adjustments are warranted for elderly patients solely based on age. CONCLUSION: Sertraline is an effective and well tolerated antidepressant for the treatment of major depressive disorder in patients aged >/=60 years. Since elderly patients are particularly prone to the anticholinergic effects of TCAs as a class, SSRIs such as sertraline are likely to be a better choice for the treatment of major depressive disorder in this age group. In addition, sertraline may have advantages over the SSRIs paroxetine, fluoxetine and fluvoxamine in elderly patients because of the drug's comparatively low potential for drug interactions, which is of importance in patient groups such as the elderly who are likely to receive more than one drug regimen.

Zoloft Approved to cope with PMS

On May 16, 2002, the FDA approved the prescription antidepressant drug Zoloft for the treatment of premenstrual dysphoric disorder (PMDD).

PMDD affects about 3%-5% of menstruating women and it is more serious form of premenstrual syndrome (PMS). The symptoms are similar to PMS -- including fatigue, mood swings, tension, irritability, change in appetite and sleep difficulties, but makes each day unbearable.

Zoloft is now the second antidepressant to be approved for treatment of PMDD. The first drug approved for this indication was Prozac (fluoxetine).

GENERIC NAME: sertraline
BRAND NAME: Zoloft

DRUG CLASS AND MECHANISM: Sertraline belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRI). Other drugs in this class are Prozac (fluoxetine), Paxil (paroxetine), Celexa (citalopram) and Luvox (fluvoxamine). Serotonin is a neurotransmitter (a chemical messenger) produced by nerve cells in the brain that is used by the nerves to communicate with one another. A nerve releases the serotonin it produces into the space surrounding it. The serotonin either travels across the space and attaches to receptors on the surface of nearby nerves or it attaches to receptors on the surface of the nerve that produced it, to be taken up by the nerve and released again (a process referred to as re-uptake). A balance is reached for serotonin between attachment to the nearby nerves and reuptake. Selective serotonin inhibitors block the reuptake of serotonin and therefore change the level of serotonin in the brain. It is believed that some illnesses such as depression are caused by disturbances in the balance between serotonin and other neurotransmitters. The leading theory is that drugs such as sertraline restore the chemical balance among neurotransmitters in the brain. Sertraline was approved by the Food and Drug Administration in December, 1991.

PREPARATIONS: Tablets: 25, 50, and 100 mg; oral concentrate: 20 mg/ml

STORAGE: Store at room temperature between 15-30°C (59-86°F).

PRESCRIBED FOR: Sertraline is a drug that is used to treat depression, obsessive-compulsive disorder, panic disorder, and post-traumatic stress disorder. Like other SSRIs, sertraline also is used for treating social anxiety disorder and postmenstrual dysphoric disorder. DOSING: The recommended dose of sertraline is 25-200 mg once daily. Treatment usually is started at 25-50 once daily and then increased at weekly intervals until the desired response is seen. Sertraline may be taken with or without food.

DRUG INTERACTIONS: Serious reactions such as hyperthermia, fluctuations in blood pressure and rigidity of muscles may occur when SSRIs are used in combination with monoamine oxidase inhibitors (MAOI) such as phenelzine, tranylcypromine (Parnate) and isocarboxazid. Therefore, SSRIs should not be used in combination with MAOIs. In addition, SSRIs and MAOIs should not be used within 14 days of each other.

Cimetidine may increase the levels in blood of sertraline by reducing the elimination of sertraline by the liver. Increased levels of sertraline may lead to more side effects.

Sertraline increases the blood level of pimozide (Orap) by 40%. High levels of pimozide can affect electrical conduction in the heart and lead to sudden death. Therefore, patients should not receive treatment with both pimozide and sertraline.

Through unknown mechanisms, sertraline may increase the blood thinning action of warfarin. The effect of warfarin should be monitored when sertraline is started or stopped.

PREGNANCY: Sertraline's safety in pregnancy has not been established.

NURSING MOTHERS: Use of sertraline by nursing mothers has not been adequately evaluated.

SIDE EFFECTS: The most common side effects of sertraline are sleepiness, nervousness, insomnia, dizziness, nausea, tremor, skin rash, upset stomach, loss of appetite, headache, diarrhea, abnormal ejaculation, dry mouth and weight loss. Important side effects are irregular heartbeats, allergic reactions and activation of mania in patients with bipolar disorder.

If sertraline is discontinued abruptly, some patients experience symptoms such as abdominal cramps, flu like symptoms, fatigue and memory impairment. Although this reaction is not well established, it is reasonable to gradually reduce the dose when therapy is discontinued.

It has been suggested that SSRIs may cause depression to worsen and even lead to suicide in a small number of patients. These potential side effects are difficult to evaluate in depressed patients because depression can progress with or without treatment, and suicide is itself a consequence of depression. Moreover, the evidence supporting these potential side effects is weak. Therefore, no conclusions can yet be drawn about the relationship between SSRIs and worsening depression and suicide. Until better information is available, patients receiving SSRIs should be monitored for worsening depression and suicidal tendencies.

Caution! Before starting to take this medicine, it is vital that you should consult your doctor! Do not use it on your own initiative, without medical advice.
Also, you should read carefully important health information about this drug given here:

www.nlm.nih.gov
my.webmd.com