November 29, 2022

Sertraline, sold under the trade names Zoloft among others, is an antidepressant of the selective serotonin reuptake inhibitor class. It is primarily used for major depressive disorder, obsessive–compulsive disorder, panic disorder, and social anxiety disorder. Effectiveness is similar to other antidepressants. Sertraline is taken by mouth. Common side effects include diarrhea, sexual dysfunction, and troubles with sleep. Serious side effects include an increased risk of suicide in those less than 25 years old and serotonin syndrome. It is unclear whether use during pregnancy or breastfeeding is safe. It should not be used together with MAO inhibitor medication. Sertraline is believed to work by increasing serotonin effects in the brain. Sertraline was approved for medical use in the United States in 1991 and initially sold by Pfizer. It is currently avaliable as a generic medication. In the United States the wholesale cost is about 1.50 USD per month as of 2018. In 2013 there wer…

Sertraline, sold under the trade names zoloft among others, is an antidepressant of the selective serotonin reuptake inhibitor class. it is primarily used for major depressive disorder, obsessive–compulsive disorder, panic disorder, and social anxiety disorder. effectiveness is similar to other antidepressants. sertraline is taken by mouth. common side effects include diarrhea,

Sexual dysfunction, and troubles with sleep. serious side effects include an increased risk of suicide in those less than 25 years old and serotonin syndrome. it is unclear whether use during pregnancy or breastfeeding is safe. it should not be used together with mao inhibitor medication. sertraline is believed to work by increasing serotonin effects in the brain. sertraline

Was approved for medical use in the united states in 1991 and initially sold by pfizer. it is currently avaliable as a generic medication. in the united states the wholesale cost is about 1.50 usd per month as of 2018. in 2013 there were over 41 million prescriptions, making it the most prescribed antidepressant and second most prescribed psychiatric medication in the

United states. sertraline is used for a number of conditions, including major depressive disorder, obsessive–compulsive disorder, body dysmorphic disorder, posttraumatic stress disorder, premenstrual dysphoric disorder, panic disorder, and social anxiety disorder. it has also been used for premature ejaculation and vascular headaches, but evidence of the effectiveness in

Treating those conditions is not robust. a 2008 review concluded that 51% of studies of various ssris yielded positive outcomes. sertraline is statistically similar in efficacy to other ssris such as paroxetine, citalopram, escitalopram and venlafaxine. evidence suggests that sertraline may be more effective than fluoxetine for some subtypes of depression. evidence does not

Show a benefit in children with depression. with depression in dementia, there is no benefit compared to either placebo or mirtazapine. tricyclic antidepressants as a group are considered to work better than ssris for melancholic depression and in inpatients, but not necessarily for simply more severe depression. in line with this generalization, sertraline was no better

Than placebo in inpatients and as effective as the tca clomipramine for severe depression. the comparative efficacy of sertraline and tcas for melancholic depression has not been studied. a 1998 review suggested that, due to its pharmacology, sertraline may be more efficacious than other ssris and equal to tcas for the treatment of melancholic depression. a meta-analysis

Of 12 new-generation antidepressants showed that sertraline and escitalopram are the best in terms of efficacy and acceptability in the acute-phase treatment of adults with unipolar mdd. reboxetine was significantly worse. comparative clinical trials demonstrated that sertraline is similar in efficacy against depression to moclobemide, nefazodone, escitalopram, bupropion,

Citalopram, fluvoxamine, paroxetine, and mirtazapine. there is low quality evidence that sertraline is more efficacious sertraline used for the treatment of depression in elderly patients was superior to placebo and comparable to another ssri fluoxetine, and tcas amitriptyline, nortriptyline and imipramine. sertraline had much lower rates of adverse effects than these tcas,

With the exception of nausea, which occurred more frequently with sertraline. in addition, sertraline appeared to be more effective than fluoxetine or nortriptyline in the older-than-70 subgroup. a 2003 trial of sertraline vs. placebo in elderly patients showed a statistically significant, but clinically very modest improvement in depression and no improvement in quality of

Life. a meta-analysis on ssris and snris that look at partial response found that sertraline, paroxetine and duloxetine were better than placebo. with respect to safety duloxetine and venlafaxine increased worsened dizziness, however not much safety data was reported. sertraline is effective for the treatment of ocd in adults and children. it was better tolerated and, based

On intention to treat analysis, performed better than the gold standard of ocd treatment clomipramine. it is generally accepted that the sertraline dosages necessary for the effective treatment of ocd are higher than the usual dosage for depression. the onset of action is also slower for ocd than for depression. cognitive behavioral therapy alone was superior to sertraline

In both adults and children; however, the best results were achieved using a combination of these treatments. treatment of panic disorder with sertraline results in a decrease of the number of panic attacks and an improved quality of life. in four double-blind studies sertraline was shown to be superior to placebo for the treatment of panic disorder. the response rate was

Independent of the dose. in addition to decreasing the frequency of panic attacks by about 80% and decreasing general anxiety, sertraline resulted in improvement of quality of life on most parameters. the patients rated as “improved” on sertraline reported better quality of life than the ones who “improved” on placebo. the authors of the study argued that the improvement

Achieved with sertraline is different and of a better quality than the improvement achieved with placebo. sertraline was equally effective for men and women. while imprecise, comparison of the results of trials of sertraline with separate trials of other anti-panic agents indicates approximate equivalence of these medications. sertraline is effective for the treatment of

Social phobia. improvement in scores on the liebowitz social anxiety scale were found with sertraline, but not with placebo. a combination of sertraline and cognitive behavioural therapy has a superior response rate when used in children. there is tentative evidence that sertraline, as well as other antidepressants, can help with the symptoms of general anxiety disorder.

The trials have generally been short in length and the medicals are associated with side effects. ssris, including sertraline, reduce the symptoms of premenstrual syndrome. side effects such as nausea are common. sertraline is effective in alleviating the symptoms of premenstrual dysphoric disorder, a severe form of premenstrual syndrome. significant improvement was

Observed in 50–60% of cases treated with sertraline vs. 20–30% of cases on placebo. the improvement began during the first week of treatment, and in addition to mood, irritability, and anxiety, improvement was reflected in better family functioning, social activity and general quality of life. work functioning and physical symptoms, such as swelling, bloating and breast

Tenderness, were less responsive to sertraline. taking sertraline only during the luteal phase, that is, the 12–14 days before menses, was shown sertraline when taken daily can be useful for the treatment of some aspects of premature ejaculation. a disadvantage of ssris is that they require continuous daily treatment to delay ejaculation significantly, and it is not clear

How they affect psychological distress of those with the condition or the person’s control over ejaculation timing. the benefit of sertraline in ptsd is not significant per the national institute of clinical excellence. others, however, the studies comparing the levels of sertraline and its principal metabolite, desmethylsertraline, in mother’s blood to their concentration

In umbilical cord blood at the time of delivery indicated that foetal exposure to sertraline and its metabolite is approximately a third of the maternal exposure. concentration of sertraline and desmethylsertraline in breast milk is highly variable and, on average, is of the same order of magnitude as their concentration in the blood plasma of the mother. as a result,

More than half of breast-fed babies receive less than 2 mg/day of sertraline and desmethylsertraline combined, and in most cases these substances are undetectable in their blood. no changes in serotonin uptake by the platelets of breast-fed infants were found, as measured by their blood serotonin levels before and after their mothers began sertraline treatment.

Compared to other ssris, sertraline tends to be associated with a higher rate of psychiatric side effects and diarrhea. it tends

To be more activating than other ssris, aside from fluoxetine. over more than six months of sertraline therapy for depression, people showed a nonsignificant weight increase of 0.1%. similarly, a 30-month-long treatment with sertraline for ocd resulted in a mean weight gain of 1.5%. although the difference did not reach statistical significance, the weight gain was lower

For fluoxetine, but higher for citalopram, fluvoxamine and paroxetine. of the sertraline group, 4.5% gained a large amount of weight. this result compares favorably with placebo, where, according to the literature, 3–6% of patients gained more than 7% of their initial weight. the large weight gain was observed only among female members of the sertraline group; the

Significance of this finding is unclear, because of the small size of the group. the incidence of diarrhea is higher with sertraline especially when prescribed at higher doses in comparison to other ssris. over a two-week treatment of healthy volunteers, sertraline slightly improved verbal fluency, but did not affect word learning, short-term memory, vigilance, flicker fusion

Time, choice reaction time, memory span, or psychomotor coordination. in spite of lower subjective rating, that is, feeling that they performed worse, no clinically relevant differences were observed in the objective cognitive performance in a group of people treated for depression with sertraline for 1.5 years as compared to healthy controls. in children and adolescents

Taking sertraline for six weeks for anxiety disorders, 18 out of 20 measures of memory, attention and alertness stayed unchanged. divided attention was improved and verbal memory under interference conditions decreased marginally. because of the large number of measures taken, it is possible that these changes were still due to chance. the unique effect of sertraline on

Dopaminergic neurotransmission may be related the fda requires all antidepressants, including sertraline, to carry a boxed warning stating that antidepressants may increase the risk of suicide in persons younger than 25 years. this warning is based on statistical analyses conducted by two independent groups of fda experts that found a twofold increase of suicidal ideation

And behavior in children and adolescents, and a 1.5-fold increase of suicidal behavior in the 18–24 age group. suicidal ideation and behavior in clinical trials are rare. for the above analysis, the fda combined the results of 295 trials of 11 antidepressants for psychiatric indications in order to obtain statistically significant results. considered separately, sertraline

Use in adults decreased the odds of suicidal behavior with a marginal statistical significance by 37% or 50% depending on the statistical technique used. the authors of the fda analysis note that “given the large number of comparisons made in this review, chance is a very plausible explanation for this difference”. the more complete data submitted later by the sertraline

Manufacturer pfizer indicated increased suicidal behavior. similarly, the analysis conducted by the uk mhra found a 50% increase of odds of suicide-related events, not reaching statistical significance, in the patients on sertraline as compared to the ones on placebo. concerns have been raised that suicidal acts among participants in multiple studies were not reported in

Published articles reporting the studies. antidepressant discontinuation syndrome is a condition that can occur following the interruption, dose reduction, or discontinuation of antidepressant drugs, including sertraline. the symptoms can include flu-like symptoms and disturbances in sleep, senses, movement, mood, and thinking. in most cases symptoms are mild, short-lived,

And resolve without treatment. more severe cases are often successfully treated by temporary reintroduction of the drug with a slower tapering off rate. acute overdosage is often manifested by emesis, lethargy, ataxia, tachycardia and seizures. plasma, serum or blood concentrations of sertraline and norsertraline, its major active metabolite, may be measured to confirm

A diagnosis of poisoning in hospitalized patients or to aid in the medicolegal investigation of fatalities. as with most other ssris its toxicity in overdose is considered relatively low. sertraline is a moderate inhibitor of cyp2d6 and cyp2b6 in vitro. accordingly, in human trials it caused increased blood levels of cyp2d6 substrates such as metoprolol, dextromethorphan,

Desipramine, imipramine and nortriptyline, as well as the cyp3a4/cyp2d6 substrate haloperidol. this effect is dose-dependent. in a placebo-controlled study, the concomitant administration of sertraline and methadone caused a 40% increase in blood levels of the latter, which is primarily metabolized by cyp2b6. sertraline is often used in combination with stimulant medication

For the treatment of co-morbid depression and/or anxiety in adhd. amphetamine metabolism inhibits enzyme cyp2d6, but has not been known to interfere with sertraline metabolism. sertraline had a slight inhibitory effect on the metabolism of diazepam, tolbutamide and warfarin, which are cyp2c9 or cyp2c19 substrates; this effect was not considered to be clinically relevant. as

Expected from in vitro data, sertraline did not alter the human metabolism of the cyp3a4 substrates erythromycin, alprazolam, carbamazepine, clonazepam, and terfenadine; neither did it affect metabolism of the cyp1a2 substrate clozapine. sertraline had no effect on the actions of digoxin and atenolol, which are not metabolized in the liver. case reports suggest that taking

Sertraline with phenytoin or zolpidem may induce sertraline metabolism and decrease its efficacy, and that taking sertraline with lamotrigine may increase the blood level of lamotrigine, possibly by inhibition of glucuronidation. clinical reports indicate that interaction between sertraline and the maois isocarboxazid and tranylcypromine may cause serotonin syndrome. in a

Placebo-controlled study in which sertraline was co-administered with lithium, 35% of the subjects experienced tremors, while none of those taking placebo did. according to the label, sertraline is contraindicated in individuals taking monoamine oxidase inhibitors or the antipsychotic pimozide. sertraline concentrate contains alcohol, and is therefore contraindicated with

Disulfiram. the prescribing information recommends that treatment of the elderly and patients with liver impairment “must be approached with caution.” due to the slower elimination of sertraline in these groups, their exposure to sertraline may be as high as three times the average exposure sertraline acts as a potent serotonin reuptake inhibitor, with an affinity for the

Serotonin transporter of 0.29 nm and an ic50 value of 2.8 nm, according to a couple of studies. it is highly selective in its inhibition of serotonin reuptake. by inhibiting the reuptake of serotonin, sertraline increases extracellular levels of serotonin and thereby increases serotonergic neurotransmission in the brain. it is this action that is thought to be responsible

For the antidepressant, anxiolytic, and antiobsessional effects of sertraline. sertraline does not have significant affinity for the norepinephrine transporter or the serotonin, dopamine, adrenergic, histamine, or acetylcholine receptors. on the other hand, it does show high affinity for the dopamine transporter and the sigma σ1 receptor. however, its affinities for these

Sites are around 100-fold or more lower than

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