What are the recommended sertraline doses for anxiety disorders. How should sertraline be properly used for depression. What are the dosage adjustments for sertraline in special populations. How to safely switch between sertraline and other antidepressants.

Understanding Sertraline: A Comprehensive Dosage Guide

Sertraline, a widely prescribed antidepressant, belongs to the selective serotonin reuptake inhibitor (SSRI) class of medications. It is used to treat various mental health conditions, including depression, anxiety disorders, and premenstrual dysphoric disorder (PMDD). To ensure optimal therapeutic benefits and minimize potential side effects, it’s crucial to adhere to the proper dosage guidelines for sertraline.

What is the standard initial dose of sertraline for adults?

The standard initial dose of sertraline for adults typically ranges from 25 mg to 50 mg, taken orally once daily. For most conditions, including major depressive disorder (MDD) and obsessive-compulsive disorder (OCD), the starting dose is usually 50 mg per day. However, for panic disorder, post-traumatic stress disorder (PTSD), and social anxiety disorder (SAD), a lower initial dose of 25 mg is often recommended.

How is the sertraline dose adjusted over time?

Sertraline dosage adjustments are made gradually, typically at intervals of at least one week. The maintenance dose can range from 50 mg to 200 mg per day, depending on the individual’s response to treatment and the specific condition being treated. It’s important to note that dose increases should be made under the guidance of a healthcare professional to ensure safety and efficacy.

Sertraline Dosage for Specific Mental Health Conditions

Sertraline is used to treat various mental health conditions, each with its own dosing regimen. Understanding the specific dosage recommendations for different disorders can help patients and healthcare providers optimize treatment outcomes.

What is the recommended sertraline dosage for depression?

For the treatment of major depressive disorder (MDD), the initial dose of sertraline is typically 50 mg once daily. The maintenance dose can range from 50 mg to 200 mg per day, with adjustments made based on the individual’s response to treatment. It’s important to note that MDD often requires several months or longer of sustained pharmacologic therapy for optimal results.

How should sertraline be dosed for obsessive-compulsive disorder (OCD)?

The dosing regimen for OCD is similar to that of depression. The initial dose is 50 mg once daily, with a maintenance dose ranging from 50 mg to 200 mg per day. As with MDD, OCD typically requires long-term treatment with sertraline to achieve and maintain symptom relief.

What is the appropriate sertraline dosage for anxiety disorders?

For anxiety disorders such as panic disorder, PTSD, and social anxiety disorder, the initial dose of sertraline is typically lower at 25 mg once daily. After one week, this is usually increased to 50 mg daily. The maintenance dose can range from 50 mg to 200 mg per day, with adjustments made based on individual response and tolerability.

Sertraline Use in Special Populations: Dosage Considerations

Certain populations may require special considerations when it comes to sertraline dosing. These include pediatric patients, individuals with liver or kidney dysfunction, and those switching from or to other antidepressant medications.

How is sertraline dosed in pediatric patients with OCD?

For children aged 6 to 12 years with OCD, the initial dose of sertraline is 25 mg once daily, with a maintenance dose range of 25 mg to 200 mg per day. Adolescents aged 13 to 17 years typically start with 50 mg once daily, with the same maintenance dose range as younger children. It’s crucial to weigh the potential risks against the clinical need when prescribing sertraline to children and adolescents.

Are there dosage adjustments for patients with liver or kidney dysfunction?

While no dosage adjustment is typically necessary for patients with kidney dysfunction, those with liver impairment may require dose modifications. For patients with mild liver dysfunction (Child-Pugh score 5 to 6), it’s recommended to use 50% of the initial and maintenance doses. Sertraline is not recommended for patients with moderate to severe liver dysfunction (Child-Pugh score 7 to 15).

Transitioning Between Antidepressants: Safe Switching Practices

Switching between antidepressants requires careful consideration to minimize potential side effects and ensure continuity of treatment. When transitioning to or from sertraline, it’s essential to follow proper protocols to maintain patient safety and treatment efficacy.

How should patients switch from a monoamine oxidase inhibitor (MAOI) to sertraline?

When switching from an MAOI to sertraline, a washout period of at least 14 days is necessary. This waiting period helps prevent potentially dangerous drug interactions that can occur when these two classes of antidepressants are used together or in close succession.

What is the recommended procedure for switching from sertraline to an MAOI?

Similarly, when transitioning from sertraline to an MAOI, a minimum of 14 days should elapse after discontinuing sertraline before starting the MAOI. This washout period is crucial to prevent serotonin syndrome, a potentially life-threatening condition that can occur when serotonin levels in the body become too high.

Managing Sertraline Treatment: Dose Adjustments and Discontinuation

Proper management of sertraline treatment involves regular assessment of its effectiveness and the potential need for dose adjustments. Additionally, when discontinuing sertraline, it’s important to follow a gradual tapering schedule to minimize withdrawal symptoms.

How should sertraline doses be adjusted during treatment?

Dose adjustments for sertraline should be made with the goal of maintaining patients on the lowest effective dose. This approach helps minimize potential side effects while still providing therapeutic benefits. Any changes in dosage should be made under the guidance of a healthcare professional and typically occur at intervals of at least one week.

What is the recommended approach for discontinuing sertraline treatment?

When discontinuing sertraline treatment, a gradual dose reduction is recommended to minimize the risk of withdrawal symptoms. The tapering schedule should be individualized based on the patient’s current dose, duration of treatment, and individual factors. A common approach is to reduce the dose by 25-50% every 5-7 days, but this can vary depending on the specific circumstances.

Sertraline for Premenstrual Dysphoric Disorder (PMDD): Unique Dosing Strategies

Sertraline is also used in the treatment of premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome. The dosing strategy for PMDD differs from that of other conditions treated with sertraline, offering both continuous and cyclic regimens.

What are the dosing options for sertraline in PMDD treatment?

For PMDD, sertraline can be administered using either a continuous or cyclic regimen. The continuous regimen involves taking sertraline daily throughout the menstrual cycle, starting with 50 mg once daily and potentially increasing to 150 mg daily. The cyclic regimen, on the other hand, involves taking sertraline only during the luteal phase of the menstrual cycle, typically starting 14 days before the anticipated onset of menstruation and continuing through the first full day of menses.

How should sertraline doses be adjusted for PMDD treatment?

Dose adjustments for PMDD treatment can include increases of 50 mg per menstrual cycle, implemented at the onset of each new cycle. Additionally, changes between continuous and cyclic regimens may be considered based on individual response and preferences. It’s important to note that the effectiveness of sertraline for PMDD beyond three months has not been systematically evaluated in controlled trials.

Maximizing Sertraline’s Efficacy: Important Considerations for Patients and Providers

To ensure the best possible outcomes with sertraline treatment, both patients and healthcare providers should be aware of several key factors that can influence its efficacy and safety.

How long does it typically take for sertraline to show therapeutic effects?

While some patients may experience improvements in mood and anxiety symptoms within the first few weeks of treatment, it often takes 4-6 weeks for the full therapeutic effects of sertraline to become apparent. Patients should be encouraged to maintain their prescribed dosing regimen during this initial period, even if they don’t notice immediate benefits.

Are there any dietary restrictions or interactions to be aware of when taking sertraline?

While sertraline doesn’t have many significant food interactions, patients should be cautious about consuming alcohol while on this medication. Alcohol can increase the risk of certain side effects and may exacerbate depression symptoms. Additionally, grapefruit and grapefruit juice should be avoided or consumed in moderation, as they can potentially increase sertraline levels in the body.

What should patients do if they miss a dose of sertraline?

If a patient misses a dose of sertraline, they should take it as soon as they remember. However, if it’s almost time for the next scheduled dose, they should skip the missed dose and continue with their regular dosing schedule. It’s important not to double up on doses to make up for a missed one, as this can increase the risk of side effects.

By understanding these key aspects of sertraline dosing and management, patients and healthcare providers can work together to optimize treatment outcomes and improve overall mental health. Regular follow-ups and open communication about any concerns or side effects are crucial for successful sertraline therapy.

Sertraline Dosage Guide + Max Dose, Adjustments

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Medically reviewed by Drugs.com. Last updated on Feb 9, 2023.

Applies to the following strengths: 20 mg/mL; 50 mg; 100 mg; 25 mg; 150 mg; 200 mg

Usual Adult Dose for:

• Depression
• Obsessive Compulsive Disorder
• Panic Disorder
• Post Traumatic Stress Disorder
• Social Anxiety Disorder
• Premenstrual Dysphoric Disorder

Usual Pediatric Dose for:

• Obsessive Compulsive Disorder

Additional dosage information:

• Renal Dose Adjustments
• Liver Dose Adjustments
• Dose Adjustments
• Precautions
• Dialysis
• Other Comments

Usual Adult Dose for Depression

Initial dose: 50 mg orally once a day
Maintenance Dose: 50 to 200 mg orally once a day

Comments:

• Dose adjustments may be made at intervals of at least one week.
• Obsessive Compulsive Disorder (OCD) and acute episodes of Major Depressive Disorder (MDD) require several months or longer of sustained pharmacologic therapy.

Uses:

• Treatment of MDD
• Treatment of OCD

Usual Adult Dose for Obsessive Compulsive Disorder

Initial dose: 50 mg orally once a day
Maintenance Dose: 50 to 200 mg orally once a day

Comments:

• Dose adjustments may be made at intervals of at least one week.
• Obsessive Compulsive Disorder (OCD) and acute episodes of Major Depressive Disorder (MDD) require several months or longer of sustained pharmacologic therapy.

Uses:

• Treatment of MDD
• Treatment of OCD

Usual Adult Dose for Panic Disorder

Initial dose: 25 mg orally once a day, increased after one week to 50 mg orally once a day
Maintenance dose: 50 to 200 mg orally once a day

Comments:

• Dose adjustments may be made at intervals of at least one week.
• These conditions generally required several months or longer of sustained pharmacological therapy beyond initial treatment.

Uses:

• Treatment of panic disorder
• Treatment of posttraumatic stress disorder (PTSD)
• Treatment of social anxiety disorder (SAD)

Usual Adult Dose for Post Traumatic Stress Disorder

Initial dose: 25 mg orally once a day, increased after one week to 50 mg orally once a day
Maintenance dose: 50 to 200 mg orally once a day

Comments:

• Dose adjustments may be made at intervals of at least one week.
• These conditions generally required several months or longer of sustained pharmacological therapy beyond initial treatment.

Uses:

• Treatment of panic disorder
• Treatment of posttraumatic stress disorder (PTSD)
• Treatment of social anxiety disorder (SAD)

Usual Adult Dose for Social Anxiety Disorder

Initial dose: 25 mg orally once a day, increased after one week to 50 mg orally once a day
Maintenance dose: 50 to 200 mg orally once a day

Comments:

• Dose adjustments may be made at intervals of at least one week.
• These conditions generally required several months or longer of sustained pharmacological therapy beyond initial treatment.

Uses:

• Treatment of panic disorder
• Treatment of posttraumatic stress disorder (PTSD)
• Treatment of social anxiety disorder (SAD)

Usual Adult Dose for Premenstrual Dysphoric Disorder

Continuous regimen:

• Initial dose: 50 mg orally once a day during the menstrual cycle
• Maintenance dose: 50 to 150 mg orally once a day during the menstrual cycle

Cyclic regimen:

• Initial dose: 50 mg orally once a day starting 14 days prior to the anticipated start of menstruation through to the first full day of menses, and repeated with each new cycle
• Maintenance dose: 50 to 100 mg orally once a day

Comments:

• The dose may be increased in increments of 50 mg per menstrual cycle, increased at the onset of each new cycle; dosage adjustments may also include changes between regimens.
• If a 100 mg once daily dose has been established with the cyclic regimen, a titration step of 50 mg per day for three days should be used at the beginning of each dosing period (luteal phase of the menstrual cycle).
• The effectiveness of sertraline for longer than three months has not been systematically evaluated in controlled trials.

Treatment of premenstrual dysphoric disorder (PMDD)

Usual Pediatric Dose for Obsessive Compulsive Disorder

6 to 12 years:

• Initial dose: 25 mg orally once a day
• Maintenance dose: 25 to 200 mg orally once a day

13 to 17 years:

• Initial dose: 50 mg orally once a day
• Maintenance dose: 50 to 200 mg orally once a day

Comments:

• The dose may be increased at intervals of at least one week.
• The potential risks versus clinical need should be assessed prior to using this drug in children and adolescents.

Use: Treatment of OCD

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

Mild liver dysfunction (Child-Pugh 5 to 6): Patients should be given 50% of the initial and maintenance doses.
Moderate to severe liver dysfunction (Child-Pugh 7 to 15): Not recommended.

Dose Adjustments

Dose adjustments should be made to maintain patients on the lowest effective dose.

Switching from:

• MAOI to this drug: At least 14 days should elapse
• This drug to MAOI therapy: At least 14 days should elapse

Treatment withdrawal:

• A gradual dose reduction is recommended instead of abrupt cessation where possible.
• If intolerable symptoms occur, it is recommended to consider resuming the previously prescribed dose and to decrease the dose at a more gradual rate.

Precautions

US BOXED WARNINGS:
SUICIDAL THOUGHTS AND BEHAVIORS:

• Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders.
• Anyone considering the use of sertraline or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need.
• Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 years and older.
• Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide.
• Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior.
• Families and caregivers should be advised of the need for close observation and communication with the prescriber.
• Sertraline is not approved for use in pediatric patients (aged 6 to 17 years) except for patients with obsessive compulsive disorder (OCD).

Safety and efficacy have not been established in patients younger than 6 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• Oral administration with grapefruit juice should be avoided.
• Doses may be given either in the morning or evening.
• Sertraline oral concentrate solution should be diluted and mixed immediately before administration.

Reconstitution/preparation techniques:

• The required dose of oral concentrate solution should be measured and mixed with half a cup of water, ginger ale, lemon/lime soda, lemonade, or orange juice only.

General:

• The single dose bioavailability of the oral tablets is approximately equal to an equivalent dose of solution.
• The need for ongoing treatment should be regularly reviewed.
• Patients should be maintained on the lowest effective dose.
• For the treatment of PTSD, OCD and panic disorder, it is not known whether the dose of sertraline needed for maintenance is identical to the dose needed to achieve an initial response.

Monitoring:

• Hepatic: Liver function
• Metabolic: Hyponatremia
• Nervous system: Serotonin syndrome
• Psychiatric: Emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior.

Patient advice:

• Tell your healthcare provider about all of the medicines that you take, including prescription and non-prescription medicines.
• This medicine may increase the risk of suicidal thoughts and behavior. Be alert for the emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. Report any behavior of concern to your healthcare provider as soon as possible.
• This medicine may cause impaired judgment, thinking, or motor skills; do not drive a car or operate dangerous machinery until you know how this drug affects you.
• Concomitant ingestion of alcohol is not advised.
• You should be advised to speak to a healthcare provider if you are pregnant, intend to become pregnant, or are breastfeeding.

Frequently asked questions

• SSRI’s vs SNRI’s – What’s the difference between them?
• How long does Zoloft (sertraline) take to work?
• Does Zoloft (sertraline) cause weight gain?
• Prozac vs Zoloft – What are the Differences & Similarities?
• How long does sertraline withdrawal last?
• What are some common side effects of antidepressants?
• Is Zoloft (sertraline) a controlled substance?
• Can I take tramadol with sertraline?

More about sertraline

• Check interactions
• Compare alternatives
• Pricing & coupons
• Reviews (4,258)
• Drug images
• Side effects
• Patient tips
• During pregnancy
• Support group
• Drug class: selective serotonin reuptake inhibitors
• Breastfeeding
• En español

Patient resources

• Drug Information
• Sertraline (Advanced Reading)
• Sertraline Tablets
• Sertraline Oral Liquid

Other brands

Zoloft

Professional resources

• Prescribing Information

Related treatment guides

• Anxiety and Stress
• Borderline Personality Disorder
• Body Dysmorphic Disorder
• Bipolar Disorder

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Zoloft Dosage Guide – Drugs.com

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Generic name: SERTRALINE HYDROCHLORIDE 25mg
Dosage forms: tablet, film coated, oral concentrate
Drug class: Selective serotonin reuptake inhibitors

Medically reviewed by Drugs.com. Last updated on Jan 15, 2023.

Dosage in Patients with MDD, OCD, PD, PTSD, and SAD

The recommended initial dosage and maximum ZOLOFT dosage in patients with MDD, OCD, PD, PTSD, and SAD are displayed in Table 1 below. A dosage of 25 mg or 50 mg per day is the initial therapeutic dosage.

For adults and pediatric patients, subsequent dosages may be increased in case of an inadequate response in 25 to 50 mg per day increments once a week, depending on tolerability, up to a maximum of 200 mg per day. Given the 24-hour elimination half-life of ZOLOFT, the recommended interval between dose changes is one week.

Dosage in Patients with PMDD

The recommended starting ZOLOFT dosage in adult women with PMDD is 50 mg per day. ZOLOFT may be administered either continuously (every day throughout the menstrual cycle) or intermittently (only during the luteal phase of the menstrual cycle, i.e., starting the daily dosage 14 days prior to the anticipated onset of menstruation and continuing through the onset of menses). Intermittent dosing would be repeated with each new cycle.

•

When dosing continuously, patients not responding to a 50 mg dosage may benefit from dosage increases at 50 mg increments per menstrual cycle up to 150 mg per day.

•

When dosing intermittently, patients not responding to a 50 mg dosage may benefit from increasing the dosage up to a maximum of 100 mg per day during the next menstrual cycle (and subsequent cycles) as follows: 50 mg per day during the first 3 days of dosing followed by 100 mg per day during the remaining days in the dosing cycle.

Screen for Bipolar Disorder Prior to Starting ZOLOFT

Prior to initiating treatment with ZOLOFT or another antidepressant, screen patients for a personal or family history of bipolar disorder, mania, or hypomania [See Warnings and Precautions (5. 4)].

Dosage Modifications in Patients with Hepatic Impairment

Both the recommended starting dosage and therapeutic range in patients with mild hepatic impairment (Child Pugh scores 5 or 6) are half the recommended daily dosage [See Dosage and Administration (2.1, 2.2)]. The use of ZOLOFT in patients with moderate (Child Pugh scores 7 to 9) or severe hepatic impairment (Child Pugh scores 10-15) is not recommended [See Use in Specific Populations (8.6), Clinical Pharmacology (12.3)].

Switching Patients to or from a Monoamine Oxidase Inhibitor Antidepressant

At least 14 days must elapse between discontinuation of a monoamine oxidase inhibitor (MAOI) antidepressant and initiation of ZOLOFT. In addition, at least 14 days must elapse after stopping ZOLOFT before starting an MAOI antidepressant [See Contraindications (4), Warnings and Precautions (5.2)].

Discontinuation of Treatment with ZOLOFT

Adverse reactions may occur upon discontinuation of ZOLOFT [See Warnings and Precautions (5. 5)]. Gradually reduce the dosage rather than stopping ZOLOFT abruptly whenever possible.

Preparation of ZOLOFT Oral Solution

ZOLOFT oral solution must be diluted before use.

•

Use the supplied calibrated dropper to measure the amount of ZOLOFT oral solution needed

•

Note: The supplied calibrated dropper has 25 mg and 50 mg graduation marks only

•

Mix with 4 ounces (1/2 cup) of water, ginger ale, lemon/lime soda, lemonade or orange juice ONLY. After mixing, a slight haze may appear, which is normal.

Instruct patients or caregivers to immediately take the dose after mixing.

Frequently asked questions

• SSRI’s vs SNRI’s – What’s the difference between them?
• Lexapro vs Zoloft: How do they compare?
• How long for an increased dose of Zoloft to work?
• How long does Zoloft (sertraline) take to work?
• Does Zoloft (sertraline) cause weight gain?
• Prozac vs Zoloft – What are the Differences & Similarities?
• How long does sertraline withdrawal last?
• What are some common side effects of antidepressants?
• Is Zoloft (sertraline) a controlled substance?
• Can I take tramadol with sertraline?

More about Zoloft (sertraline)

• Check interactions
• Compare alternatives
• Pricing & coupons
• Reviews (1,896)
• Drug images
• Side effects
• Patient tips
• During pregnancy
• Generic availability
• Support group
• Drug class: selective serotonin reuptake inhibitors
• Breastfeeding
• En español

Patient resources

• Drug Information
• Zoloft (Sertraline Oral Liquid)
• Zoloft (Sertraline Tablets)

Professional resources

• Prescribing Information

Related treatment guides

• Major Depressive Disorder
• Obsessive Compulsive Disorder
• Panic Disorder
• Depression

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Depression and anxiety in cardiac patients

Affective disorders are one of the most common pathological changes in the human mental sphere. According to WHO, from 2 to 5% of the world’s population at different periods of their lives suffer from depression and 20-30% among the contingent observed in general medical practice.

Mood disorders are even more common in selective population groups, for example, among somatic patients, depression occurs in 19-49%. Affective disorders are most common among patients with cardiovascular diseases.
E.I. Chazov (2004) emphasizes the increase in mortality from cardiovascular diseases over the period from 1990 to 2003 and relates this, in particular, to the high prevalence of depressive disorders in such patients. Some authors [Dobbels F. et al., 2000] consider depression as an independent risk factor for the development of cardiovascular diseases.
F. Lasperance (2000) highlights depression as an independent risk factor for increased mortality after myocardial infarction. In patients with depression, the proportion of repeated coronary accidents or interventions on the heart increases by more than 7% per year [Shiotani I. et al., 2002].
According to Smulevich A.B. (2005) the prevalence of anxiety-depressive and panic disorders in patients with arterial hypertension is 40 and 19%, respectively.
The criteria for diagnosing a depressive disorder include a persistent (at least 2 weeks) decrease in mood or loss of interest and pleasure in any type of activity, a change in everyday life in the form of a decrease in working capacity and social maladjustment + changes in the somatic sphere.
Depressive conditions in cardiac patients have a number of features:
• outpatient level disorders;
• polymorphism of manifestations, the presence of comorbid depressive affect disorders: anxiety, asthenia, simple and social phobias, derealization, hypochondria, asthenic autism, algia, etc.;
• anosognosia of one’s condition. Even being in a state of severe depression, noting a depressed mood, patients do not regard this as a mental disorder, but associate their condition with physical factors, exacerbation of a somatic disease, and the general social situation.
Our study was conducted on the basis of the Russian Cardiology Research and Production Complex named after. A.L. Myasnikov. Over the course of 1.5 years, 250 people who are on inpatient treatment turned to psychiatrists working on the basis of the cardiological complex. The mean age of the patients was 57.2 years. Among the examined patients, women predominated – 62%, the number of men, respectively, was 38%.
Among the mental disorders in the observed group of patients of the Cardiology Complex, organic emotionally labile disorder (33.5%), anxiety disorder (36.2%), depressive episodes, mostly mild and moderate severity (25.4%), hypochondriasis disorders (4.9%). Isolated cases of somatogenic psychoses were observed in patients in the intensive care unit.
Observed panic attacks, obsessive-compulsive, cognitive disorders were mostly comorbid.
Somatic pathology in all patients was represented by coronary heart disease in combination with hypertension of varying severity, as well as comorbid cardiac arrhythmias.
Thus, anxiety and depressive disorders were the predominant mental pathology, in some cases comorbid hypochondriacal disorders were observed.
The depressive background of mood, which was described by the patients as “bad mood”, did not have pronounced daily fluctuations, but was closely associated with additional psychotraumatic circumstances. Quite often depth of depression increased by the evening.
One of the signs of depression was the attitude of patients to their own state of health. In this regard, high hypergnosia was of great importance – the high subjective significance of experiences of bodily distress.
A pronounced affective saturation of experiences related to the somatic sphere, their specific sensual connotation was noted. The patients reduced their feelings to pains in the region of the heart and other manifestations of physical discomfort, which forced them to turn to general practitioners for medical help. The pains were persistent and did not correspond to the severity of the objective somatic pathology. It was difficult to stop with analgesics.
Very typical sleep disturbances that are devoid of any clinical patterns. These are difficulties in falling asleep, unexpected awakenings at night, delays in morning awakening, heavy, frightening dreams with fears. Sleep did not bring rest, there was a feeling of morning weakness, fatigue, which remained throughout the day, somewhat decreasing in the evening.
Patients with anxiety disorders associated their complaints with physical discomfort. Depressive affect was often combined with excitability, irritability, anger, which were revealed in any household and work situation. The reaction to everyday situations took on a hypertrophied character, over-dramatized, and caused a long-term negative affect. The feeling of mental insolvency is also characteristic: memory loss, difficulty concentrating, reduced productivity at work, combined with physical exhaustion.
Most often, anxiety for one’s well-being in the future became the cognitive content of anxiety. Patients were constantly afraid of the possibility of further serious somatic diseases, such as heart attack, stroke. Sometimes these fears reached the level of phobias.
Hypochondriacal disorders, as a rule, took place against the background of depressive affective disorders, corresponding to the content of somatic distress in the patient’s ideas. Along with real complaints of cardiac arrhythmia, vascular hypertension, persistent headaches, patients presented with a number of sensations of an indefinite nature, intolerable pain syndromes, and paresthesias. Supported hypochondriacal experiences and asthenic disorders.
Patients could hardly endure any load. There was hyperesthesia to sounds, light, restrictive behavior. Asthenia increased even more if there were additional loads that were not strong enough to overcome. The reserve of energy possibilities in such patients is extremely limited.
Externally, the patients looked depressed. Motor retardation is moderately expressed, as is the slowness of associative processes. In some cases, there was a decrease in appetite.
All this, from the point of view of patients, testified to a chronic, progressive incurable disease. In most cases, patients were not satisfied with medical care, they believed that their disease was not recognized by medical workers. Often, the depressive affect acquired an angry-malicious tone, directed at doctors and medical personnel. Patients lived in the world of their real and imaginary diseases, they demanded more and more examinations and consultations.
All this requires an integrated approach to the treatment and rehabilitation of patients in a cardiological hospital, the use of both cardiotropic and psychotropic drugs.
On the basis of RKNPK im. A.L. Myasnikov conducted a short-term study of the effectiveness of the antidepressant Zoloft (original sertraline), produced by the pharmaceutical company Pfizer, in the treatment of anxiety and depressive disorders in patients undergoing inpatient treatment in a cardiology clinic.
Study objective
Analysis of the efficacy and safety of Zoloft (sertraline) in the treatment of depressive and anxiety disorders in cardiac patients.
Zoloft (sertraline) is a specific serotonin reuptake inhibitor that has very little effect on norepinephrine and dopamine reuptake, has no stimulatory, sedative or anticholinergic effects, and, most importantly, has no cardiotoxicity.
Due to selective inhibition of the uptake of ionotropic receptors for serotonin (5-HT), sertraline does not enhance catecholaminergic activity. Sertraline has no affinity for muscarinic cholinergic receptors, serotonin, dopamine, benzodiazepine and adrenoreceptors.
Unlike tricyclic antidepressants, sertraline does not cause weight gain. In some cases, it even decreases, which is especially important in a cardiological clinic, because. overweight is a significant risk factor for the occurrence and poor prognosis of the course of cardiovascular disease. Sertraline does not cause physical and psychological dependence.
The group of patients, which consisted of 30 people, included patients with coronary heart disease with concomitant arterial hypertension. The severity of depressive disorders ranged from 21 to 25 points on the Hamilton scale, 22 patients had comorbid anxiety. All of them received Zoloft at a dose of 50 mg per day. At the same time, 1/3 of the patients had previously taken psychotropic drugs (tranquilizers, nootropics, less often antidepressants) without a pronounced effect. During the study period, only sertraline was used, other psychotropic drugs were canceled at least 5 days before the start of the study.
Methods of study
Therapy with sertraline was carried out for 4 weeks. The study used the Hamilton Depression and Anxiety Scale, the Global Clinical Impression (CGI) Scale, and the Side Effects Scale.
The somatic condition of the patients was assessed by a cardiologist using paraclinical studies (ECG, 24-hour ECG monitoring, ultrasound of the heart, blood pressure, biochemical blood test).
Completed the study 28 patients aged 35 to 70 years. Of these, 18 women and 10 men. Two patients were unable to complete treatment due to side effects. One patient developed nausea, another complained of muscle weakness and dizziness.
Results of the study
In patients treated with sertraline, by the end of the first week of therapy, there was a significant improvement in the condition, and on the fourth – a stable remission.
Patients noted an increase in the background of mood, normalization of sleep. Significantly decreased irritability, tearfulness.
The most therapeutically labile was the disturbing affect. Patients noted that they were less worried about trifles, the pace of speech changed, mental and physical hyperesthesia. The symptoms of somatic anxiety also decreased, which was manifested in the reduction of unpleasant sensations in the chest (a feeling of heaviness, pressure, heart rhythm disturbance), which was not associated with an objective picture of heart disease.
At 3–4 weeks of therapy, a trend towards regression of behavioral disorders was found: patients began to more adequately assess their condition, hypochondriacal fixation decreased. They talked about their somatic problems with less involvement. There was an opportunity and desire to maintain contact. At this stage of therapy, patients showed activity, apathetic phenomena decreased.
By the end of therapy, cognitive manifestations decreased: patients noted an improvement in memory and attention.
Against the background of the reduction of depressive disorders, the severity of asthenic manifestations decreased.
Patients have significantly decreased weakness and fatigue. Increased activity, performance and tolerance to physical activity, there was a feeling of cheerfulness. Sleep disturbances such as difficulty falling asleep, frequent awakenings, lack of feeling of rest after sleep have normalized. Increased exhaustion, hyperacusis and other phenomena of hyperesthesia disappeared. Eliminated depression, anxiety and tearfulness on a minor occasion. Anxious reactions to an unfavorable situation acquired an adequate character. Psychopathic forms of reactions in the form of irritability, anger decreased in amplitude and frequency.
The study confirmed the high efficacy and safety of Zoloft therapy (Pfizer) in the treatment of depressive and anxiety disorders in cardiac patients.
The results obtained on the effective dose of Zoloft are of considerable interest. So it was shown that the drug is quite effective at a minimum daily dose of 50 mg, the effectiveness of Zoloft does not depend on the age of the patient.
In the course of treatment with Zoloft, reliable data were obtained on improving the quality of life of patients. Most of them, after the treatment, returned to work, took an active part in family life, expanded their social circle.
Side effects when taking Zoloft are rare and their severity is negligible.
The experience of using antidepressants, in particular Zoloft, in the treatment of depression and anxiety in patients in a cardiological hospital shows the effectiveness of an integrated approach to the treatment of this group of patients, the need for interaction between doctors of various specialties, in particular cardiologists and psychiatrists, in developing methods of therapy and rehabilitation of patients.

Literature
1. Aleksandrovsky Yu.A., Romasenko L.V. Psychological and psychiatric approaches to the prevention and treatment of cardiovascular diseases // Bulletin of the Russian Academy of Medical Sciences, M., 2003, No. 12., p.24–29.
2. Vainshtein I.I., Simonov P.V. Emotional structures and the heart. M.: Nauka.1979. P. 96
3. Romasenko L.V., Khlebnikova L.Yu. Typology of depression in a therapeutic hospital // Russian Psychiatric Journal. M.–2003.–№3, p. 30–33.
4. Smulevich A.B., Syrkin A.L. Psychocardiology // M., 2005., S.777.
5. Chazov E.I. Psychosocial factors as a risk of cardiovascular diseases // Lung heart., M., 2004., No. 3., p. 2–4.
6. Lesperance F Frasure–Smith N Depression in patients with cardial disease: a practical review// J Psychosom. Res., 2000, No. 48., Pp. 379-391.
7. Tzivoni D; Gavish A; Benhorin J; Keren A; Stern S Myocardial ischemia during daily activities and stress. Am J Cardiol 1986 Aug 15;58(4):47B–50B

Fighting depression: modern drugs

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Fighting depression: modern drugs

Depression is an urgent problem, the number of visits to doctors is growing every year. It can be solved by contacting a psychotherapist and taking antidepressants . These are drugs that regulate the production of hormones and biochemical processes in the body. Assign their own is strictly prohibited, as these are complex drugs with certain restrictions, side effects . The doctor must authorize their appointment and control the intake. We will tell you which of them are the most effective and common in medicine, how many they have pluses and minuses.

What is meant by

depression

Doctors have known it since ancient Greece and Egypt. Hippocrates described it as melancholy – a condition that is accompanied by anxiety, despondency, insomnia, refusal of food, irritability. Most often, the cause is childhood trauma or severe, frequent stress in adulthood. There are many provoking factors: the death of a loved one, deterioration of living conditions, alcoholism, brain diseases. Such cases are referred to as psychogenic depression.

The second type is endogenous. The problem appears not from large external shocks, but because of internal causes. A person is constantly dissatisfied with himself, subjecting himself to criticism. Many patients have panic attacks , haunted by a feeling of fear, anxiety.

How long the period of depression lasts

Many people mistake ordinary periods of low mood for depression. If they do not last long and are quickly replaced by periods of recovery, then we are not talking about a depressive state. The problem is obvious when the symptoms persist for months and dramatically change a person’s life. Then you need to see a doctor.

What happens to the body

The most common theory is that there is a malfunction of neurotransmitters located in the brain. These substances transmit signals from neuron to neuron and are responsible for a person’s mood. Dysfunction leads to a slowdown in the rate of this transmission and a decrease in the number of neurotransmitters themselves. Serotonin, which is called the “hormone of happiness”, suffers the most. For clarity, this biochemical process can be compared, for example, with a drop in blood sugar levels in diabetes mellitus.

How is

treated depression

Depression has been treated in different ways. In the ancient world – emetics and laxatives. In the Renaissance – wine and sunbathing. In the Age of Enlightenment – external stimuli, for example, insects. The 19th century brought new recipes – in particular, a solution of camphor in tartaric acid. The treatment also included the use of drugs, which are now no longer allowed for sale, and some are recognized as narcotic.

Obviously, all these drugs had no effect on increasing the amount of serotonin. And the treatment is precisely to normalize its production. This was done after creating modern antidepressants , which have a minimum of side effects, are safe for the body and are not addictive. These are drugs, the action of which is aimed specifically at balancing the disturbed balance of neurotransmitters: serotonin, norepinephrine, dopamine.

Prescription

If a healthy person takes antidepressants , there will be no effect . For a depressed patient, taking them will help:

• improve psychological state;
• get rid of irritability;
• panic fear;
• increase mental and physical activity;
• to overcome the dreary mood.

Psychiatrists prescribe antidepressants for chronic back pain, headaches. And also with irritable bowel syndrome, incontinence and other cases when the body stops producing its own painkillers. Medication helps restore pain suppression mechanisms.

You can only take these drugs with a doctor’s prescription, as many of them are strong stimulants. Self-administration may cost dearly – the condition may worsen. Only a doctor will correctly calculate how many medicines to take per day. In parallel with the treatment by a psychiatrist, a neurologist, a consultation of a psychotherapist is required.

Precautions

• Prescribed drug start drinking from a small dose – the first couple of days they take a quarter of a tablet. Gradually increase the dose to normal. So the body adapts better. Finish the course by reducing the dose.
• The first effect of appears only 2 weeks after the start of administration. Sustained action – after six months. All this time, you need to take the remedy without making passes, breaks.

• Products are not combined with melatonin, St. John’s wort, products and dietary supplements based on sibutramine, 5-HTP. Their combination can raise serotonin to dangerous levels. Also, you can not combine them with monoamine oxidase inhibitors, for example, Cipralex. When writing a prescription, the doctor takes these points into account.

• Drinking antidepressants is better in parallel with visits to a psychotherapist. If the drugs normalize the biochemical processes in the body, then this doctor will help normalize the psychological state after depression.

The best antidepressants

In medicine, they have long argued that some drugs give only a placebo effect. The purpose of the study was to find out which of them are the most effective and valid . The project involved 116 thousand patients, and its results were published by the authoritative edition of the Lancet. We offer a list of the best.

1. Agomelatine

New generation drug. Agomelatine is used for severe depressive disorders, high levels of anxiety. Enhances the release of dopamine and norepinephrine, stimulates melatonin receptors. The standard therapeutic dose is 25-50 mg 1 time / day. Helps to restore the normal structure of sleep, get rid of anxiety and panic attacks attacks

Pros

+ Does not adversely affect attention and memory.

+ No lethargy during the day.

+ No sexual deviations.

+ No correlation with blood pressure.

+ Do not reduce dosage upon discontinuation.

Cons

— In 1-10% of cases, increased sweating, diarrhea, constipation.

– Possible increased fatigue, drowsiness.

– There are no evidence-based safety studies in people with renal or hepatic insufficiency, therefore, such patients are advised to refrain from taking drugs with active ingredient agomelatine.

2. Amitriptyline

Tricyclic antidepressant. Moreover, the World Health Organization considers Amitriptyline the most reliable in this group. The standard dose is 200-250 mg / day. The action is to block the reuptake of neurotransmitters. A good remedy for moderate to severe disorders of the endogenous type. Additionally, it has a sedative and hypnotic effect. Effective in the treatment of neuropathic pain, for the prevention of migraine.

Pluses

+ Preparations with active substance amitriptyline are inexpensive.

+ High reliability, minimum side effects.

+ Relatively safe during breastfeeding.

Cons

— Possible side effect in the form of blurred vision, dry mouth.

– Lowering blood pressure.

– Some patients experience constipation.

– Drowsiness.

3. Escitalopram

It belongs to the group of modern serotonin reuptake inhibitors (SSRIs). Most often, it is recommended to take for anxiety, panic attacks. It is taken once, the standard dose is 10 mg per day. Escitalopram has a milder effect and is prescribed to patients for whom tricyclic drugs are contraindicated.

Pluses

+ A lasting effect occurs after 3 months.

+ Indicated for patients with disorders of the cardiovascular system.

+ Soft action.

Cons

– In some patients, the functions of the gastrointestinal tract are disturbed, which is most often expressed in diarrhea.

— Anxiety may increase in the first 2 weeks, therefore it is recommended to start treatment with low doses and gradually increase them.

– Contraindicated in pregnancy and lactation.

4. Mirtazapine

A drug of the tetracyclic group. Mirtazapine – good stimulant for anxious depressions, has a moderate sedative effect. The average amount is 30 mg / day, it must be consumed once. Usually it is prescribed to patients who lose interest in life, cease to experience joy, pleasure. Effective in the correction of sleep, in particular, early awakenings.

Pros

+ Earlier onset of action than SSRIs (1 week).

+ Combines well with most drugs in the general group.

+ Full effect in 4 weeks.

+ Does not affect sexual function.

Cons

– The active substance mirtazapine is contraindicated in diabetes mellitus, arterial hypotension, increased intraocular pressure.

— During the appointment period, you must drive carefully and engage in potentially dangerous types of work.

– 18% of patients experience drowsiness, 15% dry mouth, 5% weight loss. Other side effects occur in 1-3% of cases.

5. Paroxetine

Belongs to the SSRI group, is used most often for severe anxiety, panic, social phobia, nightmares, stress after trauma. Paroxetine can resolve problems of anxious depression, anxiety-phobic disorders. Take once a day at a dose of 20 mg.

Pros

+ The most powerful stimulant among SSRIs.

+ Anxiety and insomnia pass quickly.

+ Minimal side effects in the form of vomiting, diarrhea.

+ Suitable for patients with cardiovascular problems.

Cons

— Not suitable for patients with severe motor, mental inhibition.

– Reduces libido.

– Harmful to the fetus when taken during pregnancy.

6. Fluoxetine

One of the most commonly used antidepressants in the SSRI group. Known as Prozac. Fluoxetine is also known as a good mood stimulant. Patients have a feeling of fear, tension, anxiety, gloomy dislike for others. Depending on the indications, the average daily dose is 20-60 mg.

Pluses

+ There is practically no effect on the work of the heart.

+ Does not cause sedation.

+ Effective for patients with motor retardation and excessive daytime sleepiness.

Cons

– May cause weight loss.

— Hypoglycemia is possible in diabetes mellitus.

– Contraindicated in severe renal impairment.

7. Fluvoxamine

Another SSRI drug. Fluvoxamine is similar to Prozac Fluoxetine but is fast acting and may cost cheaper. The effect is in a more active slowing down of the reuptake of serotonin by neurons. It is indicated for depression of various origins, as well as obsessive-compulsive disorders. The average daily dose is 100 mg.

Pros

+ Lower price than traditional Prozac.

+ Faster action than him.

+ Relatively minor side effects (diarrhea, dry mouth, drowsiness).

Cons

– Contraindicated in diabetes.

– Pregnant women – with caution, lactation – prohibited.

– Causes nausea in some patients.

8. Sertraline

One of the widely used and universal drugs of the SSRI group. They treat almost any depressive condition, panic disorder, social phobia. However, in severe clinical cases, sertraline may not be effective enough. The standard dose is 50 mg/day.

Pros

+ No cardiotoxicity.

+ The patient’s psychomotor activity does not change.

+ Does not increase body weight.

+ Combines well with other groups of antidepressants.

Cons

— In the first 2 weeks there may be problems with sleep, diarrhea.

– Side effects of a sexual nature.

– Contraindicated in pregnant women.

9. Venlafaxine

Belongs to the SNRI group. In addition to blocking the reuptake of serotonin, venlafaxine has a similar effect on another neurotransmitter, norepinephrine. The medicine is prescribed for depressive conditions of various origins, social phobias, anxiety, panic. Usually take 150 mg per day.

Pros

+ Better tolerated by patients than most tricyclics.

+ More pronounced effect than classic SSRIs.

+ Fewer contraindications.

Cons

– Traditional side effects for most antidepressants: nausea, drowsiness, dry mouth, diarrhea or constipation.

– May increase eye pressure.

– The most severe withdrawal syndrome among antidepressant drugs.