Zoloft or sertraline: Drug Database | Medical Device Database

13.03.197019.06.2021 by alexxlab

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Zoloft Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Effectiveness, Ease of Use, and Satisfaction

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Uses, Side Effects, Dosages, Precautions

Zoloft (sertraline) is a tablet or liquid antidepressant medication that may be prescribed to treat a number of mental health disorders including depression, premenstrual dysphoric disorder, panic disorder, obsessive-compulsive disorder, and social anxiety disorder.

Zoloft is a selective serotonin reuptake inhibitor (SSRI) that is also sold under the generic name sertraline. SSRIs prevent the reuptake of serotonin, allowing more serotonin to stay in the brain, which may improve your overall mood, sleep, and appetite, while also decreasing compulsive behaviors, symptoms of anxiety, and panic attacks.

How Zoloft Works

Zoloft belongs to a class of medications called selective serotonin reuptake inhibitors (SSRIs). As an SSRI, Zoloft blocks the reabsorption, or uptake, of serotonin in the brain, leaving more of the chemical available. Serotonin is a neurotransmitter that, among other responsibilities, helps regulate your mood, learning, and memory. In particular, serotonin is associated with positive emotions; in fact, it’s sometimes called the “happy” chemical.

Uses

Zoloft has been approved by the Food and Drug Administration (FDA) to treat:

SiberianArt / Getty Images

Off-Label Uses

Although Zoloft is not specifically FDA-approved to treat these disorders, some mental health providers or doctors may prescribe it off-label for generalized anxiety disorder, bulimia nervosa, premature ejaculation, and binge eating disorder. If you are prescribed Zoloft off-label, be sure you feel comfortable with this option, and if not, request alternative treatment options, and/or more information about why your provider is prescribing this particular medication for you.

Before Taking

When prescribing Zoloft, your treating mental health provider and/or doctor may evaluate your mental health symptoms and overall health using:

The DSM-5 to give you an official diagnosis
A physical evaluation and/or lab tests to rule out underlying health conditions that may be impacting or causing symptoms

Prior to prescribing Zoloft, your doctor will ask you questions about your symptoms, their intensity, and their frequency. They may also give you assessment questionnaires to complete. Depending on your specific needs, you may be prescribed Zoloft while also attending psychotherapy, or sometimes on its own.

Sertraline Vs. Zoloft

The FDA notes that both generic sertraline and Zoloft have similar efficacy when it comes to treating the mental health disorders for which it’s approved. However, negative perceptions of generic medications and differing non-active ingredients can impact how each drug affects each individual.

Talk to your doctor about all medications, supplements, and vitamins that you currently take. While some drugs pose minor interaction risks, others may outright contraindicate use or prompt careful consideration as to whether the pros of treatment outweigh the cons in your case.

Precautions and Contraindications

Prior to taking Zoloft, let your doctor know:

If you have an allergy to anything in Zoloft, including the inactive ingredients
If you have a history of bleeding problems, seizures, liver problems, heart problems, low sodium blood levels, thyroid disorders, or glaucoma
If you have a family history of bipolar disorder
If you are taking an additional medication that increases serotonin levels
If you are pregnant and which trimester you are in (third trimester is most at risk for complications)
If you are nursing

Zoloft is contraindicated for use with monoamine oxidase inhibitors (MAOIs), pimozide, and disulfiram (when taken with liquid Zoloft). It is critical to disclose to your doctor all current and past medications (including allergy medications), your mental health history, as well as your family medical and mental health history to ensure that Zoloft is safe for you.

Populations Most At Risk

Older adults, children diagnosed with mental health disorders other than OCD, those who are pregnant or breastfeeding, and those who are taking diuretics are at greater risk for complications and may not be prescribed Zoloft.

Other SSRIs

Examples of other SSRIs used to treat similar mental health disorders include Prozac (fluoxetine), Paxil (paroxetine), and Lexapro (escitalopram). These medications also work by increasing the amount of serotonin available in the brain.

Dosage

According to Pfizer, the recommended dosage of Zoloft will vary depending on the mental health disorder.

Major depressive disorder: The starting dosage is 50 milligrams (mg) per day with a maximum of 200 mg per day.
Obsessive compulsive disorder: The starting dosage is 25 mg per day for those 6 to 12 years old and 50 mg per day for those 13 years old and older, with a maximum dosage of 200 mg per day.
Panic disorder: The starting dosage is 25 mg per day with a maximum dosage of 200 mg per day.
Social anxiety disorder: The starting dosage is 25 mg per day with a maximum dosage of 200 mg per day.
Post traumatic stress disorder: The starting dosage is 25 mg per day with a maximum dosage of 200 mg per day.
Premenstrual dysphoric disorder: The starting dosage for intermittent dosing (during the luteal phase only) is 50 mg per day with a maximum 100 mg per day. The starting dosage for continuous dosing (during the entire month) is 50 mg per day with a maximum dosage of 150 mg per day.

Zoloft Dosage

All listed dosages are according to the drug manufacturer. Check your prescription and talk to your doctor to make sure you are taking the right dose for you.

Modifications

Certain populations may react to Zoloft differently and may require an adjusted dosage, as well as closer monitoring by their healthcare provider.

Zoloft is not approved for use by children under the age of 6.
The only FDA-approved use for children ages 6 to 17 is OCD, not any other mental health disorder.
Children 6 to 17 years old may require closer monitoring and a subsequent dosage change if during the first few months of taking Zoloft they experience significant weight loss and/or suicidal ideation.
Pregnant and nursing individuals will need to discuss the risks and benefits of Zoloft with their doctor, as it can pose a greater risk to their fetus and newborn during the third trimester and during breastfeeding.
It is recommended that older patients begin with dosages on the lower end to watch for adverse reactions prior to increasing their dosage if needed.

Liquid Zoloft

While many individuals opt to take Zoloft in tablet form, an oral liquid is available. If you have a latex sensitivity or allergy, you may not be able to take the liquid form as the dropper contains a natural rubber. If taking the oral liquid:

The solution must be diluted with half a cup of water, ginger ale, lemon aid, lemon-lime soda, or orange juice.
The dosage must be taken immediately upon dilution.

How to Take and Store

Zoloft tablets should be stored at room temperature, out of direct light, with the bottle tightly sealed. They should also be stored out of reach of children and pets.

Zoloft can be taken with or without food.
Zoloft should never be taken with alcohol or illegal drugs.
When taking Zoloft, avoid grapefruit juice and eating grapefruits as it can prevent the medication from being properly metabolized.
Zoloft should not be taken within two weeks of taking an MAOI.
When travelling, Zoloft can be stored in your carry-on or in checked baggage, although carry-on may be the safer bet in case your luggage gets lost.

If you miss a dose of Zoloft, take it as soon as you remember, unless you are due to take your next dose soon. In other words, don’t double your dosage. Keep in mind that you may experience some side effects within a few hours of your missed dosage, which may include dizziness, nausea, and feeling weak. If you have questions, be sure to reach out to your doctor.

Zoloft Overdose

If you have taken too much Zoloft (more than your typical dosage), contact your doctor right away. If they’re unavailable, call Poison Control or head to the emergency room immediately.

Side Effects

Since Zoloft alters brain chemistry, you may be worried about how taking this medication will affect you. There’s no way to predict how Zoloft will make you feel since everyone may respond differently to it. But these are the side effects to be aware of:

Common

You may experience side effects from taking Zoloft. These may include:

Diarrhea
Dizziness
Drowsiness
Dry mouth
Headache
Insomnia
Nausea
Nervousness, agitation, or restlessness
Shaking
Sweating

Sexual

Some of the most potentially bothersome side effects of Zoloft and other SSRIs are sexual issues. These can include reduced sexual desire or difficulty reaching orgasm, difficulty ejaculating, or less frequently the inability to maintain an erection (erectile dysfunction). These can be so distressing for some people that they may choose not to take the medication.

If taking Zoloft interferes with your sex life, speak with your prescribing physician.

Your doctor may suggest adding a second antidepressant. Wellbutrin (bupropion) has been found to sometimes counter the sexual side effects of SSRIs.
Your doctor may prescribe a different medication to see if another one works better for you.
Your doctor may adjust your dosage.
Your doctor may want you to take the same dosage for a bit longer, as sometimes sexual side effects get better on their own.
Your doctor may suggest taking another medication to improve sexual function. Viagra (sildenafil), Cialis (tadalafil), or Levitra (vardenafil) are all approved by the FDA to treat sexual problems in men. Some research suggests sildenafil may also improve sexual issues in some women.

Severe

Contact your doctor immediately if you experience any of the following side effects of Zoloft:

Allergic reaction symptoms like hives, rash, difficulty swallowing or breathing, and swelling of the face, mouth, throat, or tongue
Increase in suicidal thoughts or attempts
Aggression or emotional outbursts
Increase in depressive symptoms
Increase in panic attacks
Difficulty sleeping
Symptoms associated with serotonin syndrome
Increase in bruising and/or bleeding
Confusion
Headaches
Extreme nervousness, irritability, or anxiety
Rapid heart rate
Seizures
Vomiting

When to Go to the Emergency Room

If you are unable to reach your doctor, head to the emergency room right away and be sure to tell them about the medication and dosage you are currently taking and when your severe symptoms began.

Warnings and Interactions

Warnings and interactions when taking Zoloft:

If you decide you want to stop taking Zoloft, do not quit cold turkey. Talk to your doctor first so they can help you gradually wean off of Zoloft. Quitting abruptly can cause you to potentially experience some serious withdrawal symptoms.
Be mindful of any changes to your behavior, thoughts, and emotions, especially six to eight weeks after beginning the medication. If symptoms worsen, contact your doctor right away.
Zoloft can increase the risk of bleeding when taken with aspirin, anticoagulants, and nonsteroidal anti-inflammatory drugs.
Zoloft should not be taken with St. John’s Wort , 5-HTP, or SAMe as these supplements can lead to serotonin syndrome.
Illegal drugs and alcohol should not be taken while on Zoloft.
Zoloft has a “black box warning” that, in some cases, children, teenagers, and young adults (under 25) may have increased suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting the drug or after the dose is changed.

Serotonin Syndrome

In rare cases, an antidepressant such as Zoloft can cause high levels of serotonin to build up in the body. This is most likely to happen to someone who’s taking another medication that can elevate serotonin such as other antidepressants, certain pain or headache medications, and the herbal supplement St. John’s wort.

Signs and symptoms of serotonin syndrome include anxiety, agitation, sweating, confusion, tremors, restlessness, lack of coordination, and a rapid heart rate. Seek immediate medical attention if you have any of these signs or symptoms.

Informing Your Doctor

It’s important to always make sure your doctor knows which other medications, including over-the-counter medicines and supplements, you are taking.

A Word From Verywell

Keep in mind that this article does not indicate every possible outcome of taking Zoloft. It’s important to follow the guidelines given to you by your doctor and consult your doctor if you have any questions or concerns.

Uses, how to take, side effects, and interactions

Sertraline belongs to a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

Sertraline is sold under the brand name Zoloft, and there are also generic versions. It is available at most pharmacies.

Healthcare professionals can prescribe over 30 medications intended to help with depression and improve a person’s quality of life.

Sertraline is sold under the brand name Zoloft, and there are also generic versions. It is available at most pharmacies.

Share on PinterestSertraline increases the amount of serotonin that is available in the brain.
Image credit: https://commons.wikimedia.org/wiki/File:Zoloft_50_mg_(CN).JPG, 2012

Sertraline has the same mechanism of action as other SSRIs. It works by increasing the amount of serotonin that is available in the brain.

Serotonin is a neurotransmitter, or chemical messenger, that is involved in regulating many elements of a person’s daily life, including mood, sleep, rewards, learning, and memory.

Research has linked depression with low levels of serotonin.

Sertraline increases the amount of serotonin present in the brain, helping to reduce chemical imbalances and improve a person’s overall mood.

Other SSRIs include:

escitalopram (Lexapro)
citalopram (Celexa)
fluvoxamine (Luvox, Luvox CR)
fluoxetine (Prozac, Sarafem, Symbyax)
paroxetine (Paxil, Paxil CR, Pexeva)
vilazodone (Viibryd)

The Food and Drug Administration (FDA) note that people use sertraline to treat depression, anxiety, and other mood disorders.

The main use of sertraline is to treat depression, though healthcare providers also prescribe this drug to help treat other conditions, including:

A doctor may prescribe sertraline to treat other issues, such as sexual dysfunction or headaches. Anyone interested in the range of uses should consult a doctor.

Sertraline is available as either an oral tablet or a liquid.

Typically, a person takes a dose in the morning or evening, once a day. People using it to treat premenstrual dysphoric disorder may take it every day or only on select days of the month.

According to the National Alliance on Mental Illness, sertraline comes in the following doses:

25 milligram (mg) tablets
50 mg tablets
100 mg tablets
20 milligrams per liter of liquid

A person taking sertraline should follow these general guidelines:

Take it at about the same time every day.
Take with or without food.
Follow all instructions on the prescription packaging and from the doctor.
If you miss a dose, take it as soon as you remember to, but do not double the dose the next day.
Take only the amount that the healthcare provider has prescribed.

When using the liquid, dilute it in a drink. According to the National Library of Medicine, a person should mix 4 ounces (half a cup) of medication with one of the following beverages, then drink it immediately:

water
lemon soda
orange juice
lemonade
ginger ale

However, the right dosage will vary, based on a person’s age and weight.

Typically, a healthcare provider will prescribe a low dose and increase the amount over time, but no more than once per week. It can take several weeks before a person feels any effects of sertraline.

People should not stop taking the drug without speaking to a doctor, even if they are feeling better. This may mean that the drug is working, and missing a dose can result in a return of symptoms.

Side effects can vary from person to person. Talk to a healthcare provider if severe side effects occur or if any side effects do not go away.

Common side effects of sertraline include:

These side effects usually go away after the first week or two. However, sexual dysfunction often does not reduce over time.

The package insert for Zoloft states that it and other antidepressants can increase the risk of suicidal thoughts or actions in people aged 24 years or younger.

Pay close attention to any new or sudden changes in mood, behavior, thoughts, or feelings, and speak to a healthcare provider about these changes.

Other severe side effects of sertraline may include:

serotonin syndrome
low sodium levels
eye problems such as angle-closure glaucoma
increased risk of bleeding, especially when a person is also taking blood thinners or nonsteroidal anti-inflammatory drugs

In children, sertraline can cause a loss of weight and appetite. The pediatrician will likely monitor their weight.

Share on PinterestIf a person stops taking sertraline abruptly they may experience sleep problems, tinnitus, or irritability.

Whenever possible, a person should come off sertraline gradually. Stopping the dosage suddenly can cause the following side effects:

tinnitus
irritability
agitation
anxiety
nausea
dizziness
tremors
confusion
sleep problems
seizures

Sertraline contains a warning for children, teens, and adults under 24 years of age. It states that sertraline may increase a person’s suicidal thoughts or actions.

Parents and caregivers should make doctors aware of any family history of suicide. It is also important to recognize possible signs of suicidal thoughts or actions.

Adults can also experience suicidal thoughts in the first month or two of taking sertraline, as well as when the doctor increases the dosage.

Look carefully for signs such as:

agitation
irritability
acting without thinking
difficulty falling asleep or staying asleep
new or worsening anxiety
new or worsening depression
aggressive behavior
severe restlessness
frenzied or unusual excitement
extreme worry
panic attacks
thoughts of self-harm
planning or trying to commit suicide

In addition, it is important to pay close attention to side effects. If any are severe or do not go away, talk to a doctor.

People using sertraline may test positive on certain drug tests. Before taking a drug test, ask a healthcare professional for advice.

When first taking sertraline, avoid using heavy machinery or driving immediately after a dose, until it becomes clear how the body will react. Some people continue to experience dizziness, tiredness, or other effects that can impair judgment after doses.

Avoid drinking alcohol while taking sertraline.

Certain medications can interact with sertraline. An interaction can cause unwanted side effects or cause medications to be more or less potent than intended.

People should not take any monoamine oxidase inhibitors — another type of antidepressant, commonly called MAOIs — while taking sertraline or up to 2 weeks after stopping.

Taking sertraline along with other drugs that affect serotonin can increase the risk of serotonin syndrome. This syndrome involves a range of symptoms, including agitation and loss of muscle coordination.

Some drugs that affect serotonin include:

migraine medications called triptans
certain other antidepressants
some pain medications, such as tramadol
an antibiotic called linezolid

People should not take pimozide while taking sertraline. Pimozide is an antipsychotic that helps treat Tourette’s syndrome.

Also, use caution when taking medications such as ibuprofen, warfarin, and aspirin. Sertraline can increase the risk of bleeding associated with these medications.

Sertraline is available in brand and generic forms. Most insurance plans and Medicare cover the cost of the generic version of sertraline. In this case, a person will pay only the associated medication cost of their insurance plan.

People who do not have insurance may be able to use coupons to reduce the cost of sertraline.

Share on PinterestA person should discuss their medication history with their doctor before starting sertraline.

Doctors generally consider sertraline to be the preferred medication for the treatment of depression.

There is some evidence that sertraline is preferable to other antidepressants. For example, a medical review determined, based on almost 60 studies, that sertraline was more effective than other antidepressants. However, the researchers acknowledged that the majority of the studies were of low quality.

Each individual is different, and what works well for one person may not for another. Before taking sertraline, a person should discuss their medication history and family history with the doctor, who should describe the potential side effects of the drug. For some people, another option is more appropriate.

Sertraline is an antidepressant that can help treat depression and other mood disorders.

Some people find that taking sertraline helps them manage their symptoms. Others can experience side effects that are not manageable. If this happens, see a healthcare provider who can recommend alternatives, before stopping the medication.

Like other drugs, sertraline can cause mild to severe side effects. As with any treatment, discuss the benefits and potential side effects with a doctor before taking the medication.

SSRI Uses, Interactions & Common Side Effects

Zoloft (sertraline chloride) is an antidepressant developed and manufactured by Pfizer. The U.S. Food and Drug Administration approved it for sale in the U.S. in 1990. Pfizer originally sold Zoloft in the U.K. under the brand name Lustral, and it took nine years for Americans to gain access to it.

By 2005, Zoloft was the most popularly prescribed antidepressant on the U.S. market, with nearly 30 million prescriptions. In that same year, it was the sixth most prescribed brand-name prescription medication, grossing nearly $ 3.3 billion.

Pfizer lost the Zoloft patent in 2006, but announced that it would manufacture a generic version through its Greenstone division. The drug giant’s authorized generic made $2.6 billion in 2006. Even without patent, doctors wrote 41.5 million prescriptions for Zoloft by 2013.

Other manufacturers of generic sertraline include Roxane, Roerig, Teva Pharmaceuticals, Barr Laboratories, Mylan Laboratories and Dr. Reddy’s Labs.

How Does Zoloft Work?

Zoloft comes from a class of antidepressant drugs known as SSRIs (selective serotonin reuptake inhibitors). Other SSRIs include Paxil, Prozac, Symbyax, Lexapro and Celexa.

SSRIs control depression and other mental illnesses and have been around since the early 1980s. Today, they are the most prescribed class of antidepressant medication on the U.S. market. They are popular mainly due to the fact that they have fewer side effects than other types of antidepressants. SSRIs work by controlling the brain’s level of serotonin, which is a neurotransmitter thought to affect mood, sleep and learning.

Zoloft Uses

Zoloft primarily treats major depressive disorder (MDD). However, doctors also prescribe it for post-traumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), obsessive-compulsive disorder (OCD), social anxiety disorder and panic disorder. While Zoloft is not indicated for use in children, the FDA approved Zoloft to treat Obsessive-Compulsive Disorder (OCD) in children and adolescents age 6 to 17.

Diagnosis of MDD comes after some or all of the following symptoms occur for more than two weeks:

Sad or depressed mood
Changes in appetite and sleep
Mental and physical agitation
Thoughts of suicide
Loss of interest in most activities
Feeling worthless/guilty/hopeless/helpless
Difficulty concentrating

MDD affects nearly 7 percent of the U.S. adult population – if untreated, the lifetime risk of suicide is 20 percent

Off-Label Zoloft Uses

Zoloft also has several off-label uses — uses not approved by the FDA. Because Zoloft works by altering brain chemistry, some doctors may prescribe it to patients with a variety of issues. But, there is no extensive clinical trial data for off-label uses, and the FDA has not reviewed Zoloft for safety or effectiveness for these indications. There are also no official dosages for these uses.

Some off-label uses include:

Autism
Alcoholism
Diabetic neuropathy
Dementia
Eating disorders
Hot flashes
Generalized anxiety disorder
Fibromyalgia
Migraines
Personality disorders
Obesity
Tourette syndrome
Premature ejaculation

Zoloft Dosages

Zoloft and its generic forms come in both tablet and oral concentrate form. Typical dosage for treating depression is 50 mg once a day. But, the dose varies for other indications. Zoloft has a 24-hour elimination half-life, so changes in dose should not occur in intervals less than one week. As with many psychiatric medications, a patient may develop a tolerance to Zoloft. Doctors may increase the dose in order for the drug to keep working.

Disorders and their recommended dosages:

Panic Disorder, Posttraumatic Stress Disorder and Social Anxiety Disorder:: Initial dose of 25 mg once daily, increased to 50 mg after one week. Patients not responding to 50 mg may increase the dose up to 200 mg. Patients with Panic Disorder, PTSD or Social Anxiety Disorder generally need several months or longer of sustained medication, but there is no proven dosage data for lifetime maintenance treatment with Zoloft.
Premenstrual Dysphoric Disorder: Initial dose of 50 mg per day during the menstrual cycle or during the luteal phase — just before the beginning of the period. The dose for PMDD varies from 50 to 150 mg per day. Doctors may increase the dose during each menstrual cycle. Clinical trials did not test the effectiveness of Zoloft for more than three menstrual cycles.
Adult Obsessive-Compulsive Disorder:: 50 mg once daily. In trials, patients took 50 to 200 mg a day. There is no trial data for efficacy past 52 weeks.
Pediatric Obsessive-Compulsive Disorder:: Children ages 6 to 12 should start with 25 mg once daily and 50 mg in children ages 13 to 17. In clinical trials, patients used doses of 25 mg to 200 mg daily.

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Common Side Effects of Zoloft

Most patients tolerate Zoloft well, but it still has side effects that vary in severity. Common side effects of Zoloft are milder than first-generation antidepressants.

Minor side effects of zoloft that typically decrease after the first or second week of use include:

Nausea
Diarrhea
Weight loss or gain
Increased sweating
Dizziness
Sleepiness or insomnia
Tremor
Dry mouth
Headache
Restlessness
Suicidal Thoughts
Sexual Dysfunction
Fever (in children)
Urinary incontinence (in children)
Aggression (in children)

Some users experience sexual side effects, including problems with orgasm and ejaculatory delay and impotence. These do not typically decrease with use.

Black Box Warning for Suicide

Zoloft causes some younger users of the drug to report being suicidal. The FDA requires Zoloft and all antidepressants to carry a black box warning about the danger of suicide during the initial stages of treatment, especially in children. Clinical studies have shown that a small number of younger users of antidepressants, including sertraline, become suicidal.

Withdrawal Symptoms

People who stop taking SSRIs may suffer from what doctors call discontinuation syndrome. The symptoms may be most intense the first week and slowly taper off. But, some people may have a longer withdrawal period.

According to Harvard physician Dr. Joseph Glenmullen, author of The Antidepressant Solution, about 60 percent of people who took Zoloft experience withdrawal reactions. Many patients who wish to stop medication often continue to take it or increase their dose because doctors mistake withdrawal symptoms for a depressive relapse, Glenmullen said. The severity of symptoms may be dependent on dose and duration.

Symptoms of discontinuation syndrome include:

Dizziness
Loss of coordination
Fatigue
Tingling
Burning
Blurred vision
Vivid dreams
Insomnia
Flu-like symptoms
Irritability
Anxiety
Crying spells

Zoloft Side Effects in Clinical Trials

Researchers noted more serious side effects during premarket Zoloft clinical trials of over 4,000 patients. These side effects were more rare, but worth noting in studies. According to researchers, while these events occurred while receiving Zoloft, there is no definite proof that Zoloft caused these adverse events.

Reported Side Effects Include

Gynecomastia
Urinary problems
Flu-like symptoms
Menstrual disorder
Breast pain
Amnesia
Hallucination
Delusions
Thirst
Anemia
Aggression
Ear and eye pain
Muscle cramps
Weight increase
Back pain
Weight loss
Seizures

Zoloft and Autism

One of the most recent side effects linked to the use of Zoloft and other SSRIs during pregnancy is autism spectrum disorder, also referred to as ASD. ASD is a developmental disorder that impairs a person’s ability to communicate and interact.

“Our study has established that taking antidepressants during the second or third trimester of pregnancy almost doubles the risk that the child will be diagnosed with autism by age 7, especially if the mother takes selective serotonin reuptake inhibitors, often known by its acronym SSRIs.”

A 2015 study published in JAMA Pediatrics showed that Zoloft and other SSRIs were associated with a 200 percent increased risk of having a child born with autism while antidepressants in general had an 87 percent overall increased risk.

Boys are more likely to be diagnosed with autism than girls, and older mothers are more likely to have autistic children.

A Johns Hopkins study from April 2014 published in Pediatrics, showed boys born to mothers who used SSRIs during pregnancy were three times more likely to be autistic.

Zoloft and Pregnancy

Women who are pregnant or considering becoming pregnant should consult their doctors prior to taking Zoloft or continuing treatment. Studies show Zoloft may cause serious birth defects when taken during pregnancy, as well as withdrawal symptoms in the baby following birth.

Babies born to mothers who take Zoloft are more likely to suffer from (PPHN).

Women who take Zoloft during the third trimester of pregnancy gave birth to babies who required prolonged hospitalization, respiratory support and tube feeding, according to premarketing studies.

While the FDA no longer uses pregnancy categories to determine a drug’s safety during pregnancy, it previously categorized Zoloft a category C drug. This means that animal studies have shown some harm to the fetus, but there have been no adequate studies in humans.

Research shows, however, that babies born to mothers who have taken Zoloft or another SSRI after the 20th week of pregnancy are more likely to suffer from persistent pulmonary hypertension of the newborn (PPHN), which is fatal in 10 percent of cases. In addition, one study showed that women taking sertraline had twice the risk of having a baby born with a heart defect.

Using SSRIs while pregnant — or even up to a month before conception — can lead to a fatal birth defect called anencephaly, in which a large portion of the brain and skull never develops. In addition, babies are more likely to suffer from facial malformations such as cleft lip and cleft palate if a mother took an SSRI during pregnancy. Taking an antidepressant while pregnant can also put babies at risk for withdrawal symptoms. The side effects can be serious, but the risk of a birth defect occurring is relatively low.

A handful of Zoloft lawsuits blamed the drug for birth defects. Most were withdrawn or dismissed.

Drug Interactions

Patients with kidney disease or liver disease, or who suffer from seizures, mania or suicidal thoughts, should speak to their doctor before using Zoloft. Patients who are allergic to ingredients in Zoloft should not take it. In addition, Zoloft can cause interactions with other drugs or supplements.

Zoloft interactions with other drugs

Taking Zoloft with NSAID pain relievers or blood thinners such as warfarin (Coumadin) may increase the risk of stomach bleeding.
Zoloft should not be taken with alcohol
Do not take St. John’s Wort with Zoloft
Lithium combined with SSRIs like Zoloft can cause serotonin syndrome
MAOIs or tryptamine-based drugs for headaches combined with Zoloft may cause serotonin syndrome

Doctors typically will decrease the dosage of an SSRI before stopping treatment altogether. Otherwise, withdrawal symptoms can occur, including irritability, nausea, dizziness, vomiting, nightmares and headache.

Serotonin syndrome is a serious condition that can be recognized by the following symptoms:

Nausea or vomiting
Agitation
Loss of coordination
Diarrhea
Rapid heartbeat
Hallucinations

Sertraline – StatPearls – NCBI Bookshelf

Continuing Education Activity

Sertraline is a medication used to manage and treat major depressive disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, premenstrual dysphoric disorder, and social anxiety disorder. It is in the SSRI class of medications. This activity outlines the indications, action, and contraindications for sertraline as a valuable agent in the treatment of major depressive disorder and other disorders. This activity will highlight the mechanism of action, adverse event profile, and other key factors (e.g., off-label uses, dosing, monitoring, relevant interactions) pertinent for members of the interprofessional healthcare team in treating patients with major depressive disorder and related conditions.

Objectives:

Identify the mechanism of action of sertraline.
Describe the adverse effects of sertraline.
Review the appropriate monitoring for sertraline.
Summarize interprofessional team strategies for improving care coordination and communication to advance sertraline and improve outcomes.

Earn continuing education credits (CME/CE) on this topic.

Indications

Sertraline is an antidepressant used as a first-line treatment of major depressive disorder. The Food and Drug Administration (FDA) has also approved other indications for sertraline, including the treatment of obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, premenstrual dysphoric disorder, and social anxiety disorder.

There are many off-label, non-FDA-approved uses for sertraline. Sertraline has been used to treat many psychiatric conditions, including binge eating disorder, body dysmorphic disorder, bulimia nervosa, generalized anxiety disorder, and premature ejaculation.[1][2][3]

Mechanism of Action

Sertraline is an antidepressant medication within the selective serotonin reuptake inhibitors (SSRIs) class. Sertraline is an antidepressant with primarily inhibitory effects on presynaptic serotonin reuptake. This inhibition of serotonin reuptake results in an accumulation of serotonin. Serotonin in the central nervous system plays a role in regulating mood, personality, and wakefulness, which is why blocking serotonin reuptake is thought to be beneficial in disorders such as major depression. Sertraline also has minimal effects on norepinephrine and dopamine uptake, and research has shown that it has more dopaminergic activity than other medications in the same SSRI class. Sertraline’s mechanism of action makes it highly efficacious when used in the treatment of various psychiatric conditions. [4][5][2]

Administration

Sertraline is orally administered once daily in the morning or evening. If the patient experiences somnolence with sertraline, administer it in the evening. Available dosages in the oral tablet form are 25 mg, 50 mg, 100 mg, and solution form 20mg/ml. The absorption of sertraline may be improved when taken with food.[6]

Per FDA recommendation, the starting dose for major depressive disorder is 50 mg/day, but for PTSD, PD and ASD are 25mg/day. The sertraline dose increase in 50 mg/day increments at weekly intervals up to a maximum of 200 mg/day. Sertraline dosing is generally once daily, and administration may be at any time of the day.[7]

Adverse Effects

SSRIs, considered a newer class of antidepressants, are better tolerated than tricyclic antidepressants or monoamine oxidase inhibitors. The primary side effects of sertraline include syncope, lightheadedness, diarrhea, nausea, sweating, dizziness, xerostomia, confusion, hallucinations, tremor, somnolence, impotence, a disorder of ejaculation, fatigue, rhinitis, and female sexual disorder.

There is a bleeding risk associated with sertraline, as it may inhibit platelet aggregation.

Sertraline can prolong the QT interval; however, the prolongation is dose-dependent and is very modest. Furthermore, this risk is higher in citalopram rather than sertraline or other SSRIs.

Sertraline may rarely produce symptoms of serotonin syndrome, though this generally happens when combining it with another serotonergic medication. These symptoms include myoclonus, muscle rigidity, diaphoresis, tremor, hyperreflexia, agitated delirium, and hyperthermia.

Sertraline, like other antidepressants, may increase the risk of suicidal ideation and behavior in children, adolescents, and young adults with major depression.

Sertraline use requires caution in patients 65 years and older. It is identified in the Beers Criteria as a high-risk medication in geriatric patients, as it may induce a syndrome of inappropriate antidiuretic hormone or hyponatremia.[5][8][9][10]

Sertraline use in the first trimester of pregnancy increased the risk of cardiovascular-related malformations such as atrial and/or ventricular septal defects in infants. [11]

Contraindications

Sertraline is contraindicated in patients with documented hypersensitivity to the drug or its components. The coadministration of sertraline with thioridazine, pimozide, or monoamine oxidase inhibitors, including linezolid or methylene blue, is also contraindicated. Patients who are taking other serotonergic medications should receive education regarding the risks of coadministration with sertraline. Sertraline is contraindicated with disulfiram only in solution form as it contains 12% alcohol, and it may cause an alcohol-disulfiram reaction.

Sertraline therapy should not start within two weeks of discontinuing any monoamine oxidase inhibitor to prevent toxicity with serotonin syndrome.

There is a US black box warning for use in pediatric patients and young adults. Use with caution in patients who are ages 18 to 24 years old due to the risk of an increase in suicidal ideation.[12]

Monitoring

It is essential to monitor patients for unusual changes in behavior, anxiety, suicidality, or any other clinical signs of worsening illness. Regularly evaluate for depression and suicidality, especially when changing the dose of sertraline. Sertraline may also precipitate mania in patients who are at risk for bipolar disorder. Monitor for symptoms of mania in patients who are started on sertraline, especially if they have a family history of mania or bipolar disorder.

Monitor for abnormal bleeding, adverse effects of medication use, or withdrawal symptoms from abrupt discontinuation in patients taking sertraline. The abnormal bleeding may primarily occur if used concurrently with aspirin, NSAIDs, warfarin, or other anticoagulants, as sertraline may impair platelet aggregation and cause bruising, epistaxis, or hemorrhage.

For geriatric patients, monitor for changes in mental status, and check their sodium concentration regularly due to the risk of SIADH or hyponatremia.

Sertraline is considered safe in patients with a history of myocardial infarction, heart failure, and other cardiac conditions. However, due to the minor effect of QT prolongation, it may benefit the provider to monitor the QT interval with electrocardiograms.

Sertraline is also considered safe in pregnancy and with breastfeeding. Although not mandatory, therapeutic drug monitoring may be a consideration to ensure the safety of pregnant patients and infants who may have exposure to the medication.[13][14][15][16][17]

Toxicity

The overdose of sertraline is generally well-tolerated. Sertraline toxicity may result in serotonin syndrome, resulting in myoclonus, muscle rigidity, diaphoresis, tremor, hyperreflexia, agitated delirium, and hyperthermia. Treatment of serotonin syndrome requires discontinuing the medication and supportive care. Consider antiemetics (non-serotonergic), benzodiazepines, and standard cooling measures for symptom relief. The patient can also receive serotonin antagonists such as cyproheptadine. If there is severe toxicity and the patient develops muscular rigidity and hyperthermia with body temperatures higher than 41 degrees C, consider sedation, endotracheal intubation, external cooling, and neuromuscular paralysis. It is important to note that antipyretics are likely not beneficial to patients experiencing hyperthermia due to serotonin syndrome.[18]

Enhancing Healthcare Team Outcomes

Healthcare providers who often prescribe sertraline include primary care physicians, psychiatrists, nurse practitioners, and others, functioning as an interprofessional team. All healthcare team members must follow the patient regularly to monitor for the reduction of symptoms or any adverse effects. All providers should know the medication’s contraindications, adverse effects, and interactions with other drugs. It is also essential to educate all patients who are prescribed sertraline on the possible adverse effects and the prevention and recognition of toxicity due to sertraline (in combination with other serotonergic drugs). Patient education regarding medication use and compliance will improve outcomes and ensure patient safety.

Patient safety can also be improved when dosing adjustments are considered by health care professionals who are a part of a patient’s care team. Elderly patients may need dosing adjustments, as they may tolerate lower doses better. Patients with medical conditions affecting their liver may also need decreased doses for better tolerability.

Clinicians require vigilance regarding the toxic effects of serotonergic medications and ensure not to prescribe multiple medications that can cause serotonin syndrome, which is possible by preventing polypharmacy and minimizing unnecessary use of these drugs; this is one of the areas where the pharmacist can provide valuable input to the team as they monitor and verify the patient’s medication regimen as well as monitor dosing of sertraline and other drugs. Furthermore, should a patient need to be switched to a different serotonergic medication, physicians and other healthcare team members must ensure that no new medication starts until at least two weeks after the discontinuation of sertraline.[18] Nursing can play a significant role in this type of monitoring, ensuring patient compliance, providing counsel, assessing therapeutic effectiveness, being aware of potential adverse drug reactions, and alerting the team of any concerns. Only with this type of cohesive interprofessional team coordination can sertraline therapy provide an optimal therapeutic benefit while minimizing adverse events. [Level 5]

Continuing Education / Review Questions

References

1.: Fenske JN, Schwenk TL. Obsessive compulsive disorder: diagnosis and management. Am Fam Physician. 2009 Aug 01;80(3):239-45. [PubMed: 19621834]
2.: Cipriani A, La Ferla T, Furukawa TA, Signoretti A, Nakagawa A, Churchill R, McGuire H, Barbui C. Sertraline versus other antidepressive agents for depression. Cochrane Database Syst Rev. 2010 Apr 14;(4):CD006117. [PMC free article: PMC4163971] [PubMed: 20393946]
3.: Aigner M, Treasure J, Kaye W, Kasper S., WFSBP Task Force On Eating Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of eating disorders. World J Biol Psychiatry. 2011 Sep;12(6):400-43. [PubMed: 21961502]
4.: Kitaichi Y, Inoue T, Nakagawa S, Boku S, Kakuta A, Izumi T, Koyama T. Sertraline increases extracellular levels not only of serotonin, but also of dopamine in the nucleus accumbens and striatum of rats. Eur J Pharmacol. 2010 Nov 25;647(1-3):90-6. [PubMed: 20816814]
5.: Sanchez C, Reines EH, Montgomery SA. A comparative review of escitalopram, paroxetine, and sertraline: Are they all alike? Int Clin Psychopharmacol. 2014 Jul;29(4):185-96. [PMC free article: PMC4047306] [PubMed: 24424469]
6.: Hicks JK, Bishop JR, Sangkuhl K, Müller DJ, Ji Y, Leckband SG, Leeder JS, Graham RL, Chiulli DL, LLerena A, Skaar TC, Scott SA, Stingl JC, Klein TE, Caudle KE, Gaedigk A., Clinical Pharmacogenetics Implementation Consortium. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2D6 and CYP2C19 Genotypes and Dosing of Selective Serotonin Reuptake Inhibitors. Clin Pharmacol Ther. 2015 Aug;98(2):127-34. [PMC free article: PMC4512908] [PubMed: 25974703]
7.: Preskorn SH, Lane RM. Sertraline 50 mg daily: the optimal dose in the treatment of depression. Int Clin Psychopharmacol. 1995 Sep;10(3):129-41. [PubMed: 8675965]
8.: Beach SR, Kostis WJ, Celano CM, Januzzi JL, Ruskin JN, Noseworthy PA, Huffman JC. Meta-analysis of selective serotonin reuptake inhibitor-associated QTc prolongation. J Clin Psychiatry. 2014 May;75(5):e441-9. [PubMed: 24922496]
9.: By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019 Apr;67(4):674-694. [PubMed: 30693946]
10.: Varela Piñón M, Adán-Manes J. Selective Serotonin Reuptake Inhibitor-Induced Hyponatremia: Clinical Implications and Therapeutic Alternatives. Clin Neuropharmacol. 2017 Jul/Aug;40(4):177-179. [PubMed: 28622213]
11.: Shen ZQ, Gao SY, Li SX, Zhang TN, Liu CX, Lv HC, Zhang Y, Gong TT, Xu X, Ji C, Wu QJ, Li D. Sertraline use in the first trimester and risk of congenital anomalies: a systemic review and meta-analysis of cohort studies. Br J Clin Pharmacol. 2017 Apr;83(4):909-922. [PMC free article: PMC5346877] [PubMed: 27770542]
12.: DeVane CL, Liston HL, Markowitz JS. Clinical pharmacokinetics of sertraline. Clin Pharmacokinet. 2002;41(15):1247-66. [PubMed: 12452737]
13.: Glassman AH, O’Connor CM, Califf RM, Swedberg K, Schwartz P, Bigger JT, Krishnan KR, van Zyl LT, Swenson JR, Finkel MS, Landau C, Shapiro PA, Pepine CJ, Mardekian J, Harrison WM, Barton D, Mclvor M., Sertraline Antidepressant Heart Attack Randomized Trial (SADHEART) Group. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA. 2002 Aug 14;288(6):701-9. [PubMed: 12169073]
14.: O’Connor CM, Jiang W, Kuchibhatla M, Silva SG, Cuffe MS, Callwood DD, Zakhary B, Stough WG, Arias RM, Rivelli SK, Krishnan R., SADHART-CHF Investigators. Safety and efficacy of sertraline for depression in patients with heart failure: results of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) trial. J Am Coll Cardiol. 2010 Aug 24;56(9):692-9. [PMC free article: PMC3663330] [PubMed: 20723799]
15.: Paulzen M, Goecke TW, Stickeler E, Gründer G, Schoretsanitis G. Sertraline in pregnancy – Therapeutic drug monitoring in maternal blood, amniotic fluid and cord blood. J Affect Disord. 2017 Apr 01;212:1-6. [PubMed: 28129551]
16.: Pinheiro E, Bogen DL, Hoxha D, Ciolino JD, Wisner KL. Sertraline and breastfeeding: review and meta-analysis. Arch Womens Ment Health. 2015 Apr;18(2):139-146. [PMC free article: PMC4366287] [PubMed: 25589155]
17.: Leverich GS, Altshuler LL, Frye MA, Suppes T, McElroy SL, Keck PE, Kupka RW, Denicoff KD, Nolen WA, Grunze H, Martinez MI, Post RM. Risk of switch in mood polarity to hypomania or mania in patients with bipolar depression during acute and continuation trials of venlafaxine, sertraline, and bupropion as adjuncts to mood stabilizers. Am J Psychiatry. 2006 Feb;163(2):232-9. [PubMed: 16449476]
18.: Wang RZ, Vashistha V, Kaur S, Houchens NW. Serotonin syndrome: Preventing, recognizing, and treating it. Cleve Clin J Med. 2016 Nov;83(11):810-817. [PubMed: 27824534]

Zoloft (Sertraline) | Selective Serotonin Reuptake Inhibitors

Zoloft (sertraline) is a prescription antidepressant drug. It belongs to a group of antidepressant medications called selective serotonin reuptake inhibitors (SSRIs). This medication is often used to treat depression experienced by adults and teenagers. This medication may also be used to treat adults and teenagers who experience panic attacks, posttraumatic stress, social anxiety, premenstrual dysphoric issues, and obsessive compulsive thoughts and behaviors. Zoloft may help to control the emotions, thoughts, and actions that sometimes accompany these mental health conditions, but it will not cure the conditions.

FAQs

How should I take this medication?
Zoloft comes in both tablet and concentrated liquid form and is usually taken once per day, with or without food. The concentrated liquid must be diluted with water, ginger ale, orange juice, lemon lime soda, or lemonade. Drink the diluted mixture immediately. Do not dilute this medication with any other liquid. Your healthcare advisor may adjust your dosage until he or she finds the best dosage to relieve your symptoms. You may need to take this medication for several weeks before you begin to feel the effects of this drug. It is important to continue taking this drug as prescribed by your healthcare advisor, even after you begin to feel better.
What should I do if I miss a dose?
As soon as you remember it, take the dose you missed. If it will soon be time for your next regular dose, skip the missed dose altogether. You should not take a double dose to make up for missed medication. Taking two doses over a short period of time may lead to an overdose.
What should I do if I take too much of this medication?
Call a poison control center, call your healthcare provider, and seek urgent medical attention immediately. An overdose of this medication may be fatal. Symptoms of overdose include vomiting, dizziness, seizures, irregular heartbeat, high blood pressure, hallucinations, breathing difficulties, fainting, and coma.
Who should not take this medication?
People who are allergic to sertraline should avoid this medication. Allergic reactions may include difficulty breathing, rashes or hives, and swelling of the lips, tongue, eyes or face. Elderly people should not take this medication unless it is being used to treat obsessive compulsive behavior. Children should not be given this drug. Individuals who take medications such as pimozide, Antabuse, monoamine oxidase inhibitors (MAOIs), or those who have used an MAOI in the past two weeks should not use Zoloft as serious or life-threatening effects may occur. Do not share your medication with other individuals, even if they have been diagnosed with the same health issues.
What are some ways to get the most out of my treatment with this medication?
Zoloft is prescribed by doctors and psychiatrists for many mental health conditions that also benefit from treatment with psychotherapy. While this medication may allow you to receive better treatment in the face of debilitating symptoms, it will not teach you positive coping skills, help you understand what you are experiencing, or help you develop a healthy self-care routine. Finding a therapist or counselor to work with may help you fill in some of the gaps that occur from treating mental health conditions with drugs alone. Additionally, a mental health professional may help you develop healthy lifestyle changes that facilitate better, longer-lasting mental health outcomes.
How should I store this medication?
Zoloft should be tightly sealed in its original container when not in use. Store the container at room temperature. Avoid locations that are exposed to excess heat or moisture (such as a bathroom or kitchen).

Warning Considerations

Teenagers and young adults may experience an increase in suicidal thoughts and actions, particularly during the first few months of treatment. Similar effects may be experienced when the dose is adjusted.

Long-term use of this medication has been linked with a severe and potentially fatal condition called serotonin syndrome. Symptoms of this condition include muscle twitching, muscle rigidity, fast heartbeat, excessive sweating or fever, nausea, vomiting, diarrhea, drastic changes in mood, agitation, hallucinations, and loss of consciousness.

Before taking any psychotropic medication, including Zoloft, it is important to discuss your complete health history and medication use with your doctor. You should also mention any serious reactions you may have had to other similar medications. If you drink alcohol on a regular basis, talk to your doctor about interactions this drug may have as a result of your alcohol use.

Zoloft may interact with other medications or supplements, including but not limited to:

Antabuse (disulfiram)
Antihistamines
Anticoagulants
Antidepressants
Antifungals
Medications for sleep issues
Natural herbs, especially St. John’s wort
Medications for pain relief
Medication for issues with blood pressure
Migraine medications
Minerals
Vitamins

If you are taking any prescription drugs or regularly taking supplements, consult with your physician before beginning treatment with this drug.

Important Information During Use

SSRIs carry significant risks of which to be aware. If you are prescribed this drug, your doctor and/or pharmacist should share the following warnings with you:

If you are pregnant or become pregnant while taking Zoloft, ask your doctor if there are other treatments that would work for your condition. This drug may cause problems in newborns if taken during pregnancy or while breastfeeding.
Zoloft can make you extremely drowsy. Try to refrain from driving or operating heavy machinery or engaging in intense phsysical activity until you know for sure how this drug affects you.
Alcohol may intensify the potential side effects of this medication.
If you are scheduled for surgery or plan on having surgery, be sure to let your surgeon know that you are taking this medication. This warning includes oral surgery.

Possible Side Effects

Side effects from Zoloft will be different for each person. Some people who take it experience no side effects at all. Serious side effects from this medication may include:

Unclear vision
Seizures
Rapid or irregular heartbeat
Abnormal bleeding, bruising, or blistering
Auditory or visual hallucinations
Mania
Stiff muscles
Flu-like symptoms such as fever or excessive sweating

Less serious side effects of taking this drug can include:

Drowsiness
Disorientation
Dry mouth
Changes in appetite or weight
Restlessness
Stomach issues, gas, vomiting, diarrhea, or constipation
Low sodium levels in blood
Headache
Pain or tingling in extremities
Noticeable differences in sex drive or ability
Unwarranted tremors or shaking
Sore or tight throat

How to Safely Withdraw

People who are taking Zoloft should not stop taking the drug all at once. Formulate a plan with your doctor before reducing or discontinuing this medication altogether. You can reduce the symptoms you feel during withdrawal by slowly reducing this medication in your system. Possible symptoms of withdrawal may include:

Speak with your doctor about any negative symptoms that you experience when you stop using this medication.

References:

Citizens Commission on Human Rights International. (2012). The side effects of common psychiatric drugs. Retrieved from http://www.cchrint.org/pdfs/The_Side_Effects_of_Common_Psychiatric_Drugs.pdf
Drugs.com. (2014). Zoloft. Retrieved from http://www.drugs.com/zoloft.html
Medline Plus. (2014). Sertraline. Retrieved from http://www.nlm.nih.gov/medlineplus/druginfo/meds/a697048.html
RxList. (2014). Zoloft. Retrieved from http://www.rxlist.com/zoloft-drug.htm
United States Food and Drug Administration. (2012). Medication guide: Zoloft. Retrieved from http://www.fda.gov/downloads/drugs/drugsafety/ucm089832.pdf

Page content reviewed by James Pendleton, ND.

Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ^®, contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

Trade names: USA

Zoloft

Trade names: Canada

ACT Sertraline [DSC]; AG-Sertraline; APO-Sertraline; Auro-Sertraline; BIO-Sertraline; DOM-Sertraline; JAMP-Sertraline; Mar-Sertraline; MINT-Sertraline; MYLAN-Sertraline [DSC]; NRA-Sertraline; PMS-Sertraline; Priva-Sertraline; RAN-Sertraline; RIVA-Sertraline; SANDOZ Sertraline; TEVA-Sertraline; VAN-Sertraline [DSC]; Zoloft

Warning

Drugs like this have increased the likelihood of suicidal thoughts or actions in children and young people.This risk may be higher in people who have attempted suicide or have had suicidal thoughts in the past. All people taking this drug must be closely monitored. Call your doctor right away if you have signs such as depressed mood (depression), nervousness, anxiety, grumpiness, or anxiety attacks, or if other mood or behavior changes occur or worsen. Call your doctor right away if you have suicidal thoughts or attempted suicides.

What is this drug used for?

The drug is used to treat depression.
It is used to treat obsessive-compulsive disorder.
Used to treat panic attacks.
Used to treat Post Traumatic Stress Disorder (PTSD).
It is used to treat emotional lability in women in the premenstrual period.
This medication is used to treat social anxiety disorder.
This medicinal product can be used for other indications. Consult your doctor.

What should I tell my doctor BEFORE taking this drug?

All forms of issue:

If you are allergic to sertraline or any of the other ingredients of this medicine.
If you are allergic to this drug, any of its ingredients, other drugs, foods or substances. Tell your doctor about your allergy and how it manifested itself.
If you have liver disease.
If you are taking any of the following drugs: linezolid or methylene blue.
If you are taking pimozide.
If you have taken a drug for depression or Parkinson’s disease in the past 14 days. These include isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline. An episode of very high blood pressure may occur.
If you are taking any medications that can cause certain types of heart rhythm disturbances (prolonged QT interval).There are many medications that can cause these problems. If you are unsure, check with your doctor or pharmacist.
If you are pregnant or may become pregnant. Some forms of this drug are not intended for use during pregnancy.

Liquid:

If you are allergic to latex. The pipette has an elastic band.
If you are taking disulfiram.

This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

Tell your doctor and pharmacist about all the medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems. You need to make sure that this drug is safe for your medical condition and in combination with other drugs you are already taking. Do not start or stop taking any medication or change the dosage without your doctor’s approval.

What do I need to know or do while taking this drug?

Tell all healthcare providers that you are taking this drug. These are doctors, nurses, pharmacists and dentists.
Avoid driving or other activities that require increased attention until you see how this drug affects you.
Do not stop taking this drug abruptly without talking to your doctor.This can increase the risk of side effects. If necessary, this drug should be stopped gradually as directed by your doctor.
Avoid drinking alcohol while taking this drug.
Consult your doctor before using marijuana, other forms of cannabis, prescription or over-the-counter drugs that may slow you down.
Sleep and appetite may improve quickly if you are depressed after starting this drug.Other symptoms of depressed mood may take up to 4 weeks to improve.
This drug may increase the chance of bone fractures. Consult your doctor.
This drug may increase the risk of bleeding. Sometimes bleeding can be life-threatening. Consult your doctor.
This drug may lower sodium levels. Very low sodium levels can be life-threatening, leading to seizures, fainting, difficulty breathing, or death.
The risk of eye problems may be increased in some patients with this drug. Your doctor may order you to see an ophthalmologist to see if you are at increased risk of developing these eye problems. Call your doctor right away if you have eye pain, change in vision, swelling, or redness around the eye.
A serious and sometimes fatal complication called serotonin syndrome can occur. This risk may increase with the concomitant use of certain other drugs.Call your doctor right away if you have anxiety, imbalance, confusion, hallucinations, fever, tachycardia or irregular heartbeat, flushing, muscle twitching or stiffness, seizures, tremors or tremors, excessive sweating, severe diarrhea, nausea or vomiting , very severe headache.
This drug may interfere with some laboratory tests. Tell all healthcare providers and laboratory staff that you are taking this drug.
If you are 65 years of age or older, use this drug with caution. You may have more side effects.
This drug is not approved for use in children of all ages. Check with your doctor to make sure this drug is right for your child.
Use with caution in children. Consult your doctor.
In some cases, the drug may affect the growth rate in children and adolescents. They may need to check their growth rate regularly.Consult your doctor.
Taking this drug late in pregnancy may increase the risk of breathing or eating problems, low body temperature, or withdrawal symptoms in a newborn. Please consult your doctor.
Tell your doctor if you are breastfeeding. It is necessary to consult if the drug poses any risk to the child.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, some people with this drug can have serious and sometimes deadly side effects. Call your healthcare professional or get medical attention right away if you have any of the following signs or symptoms, which may be associated with serious side effects:

Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
Signs of low sodium levels such as headache, trouble concentrating, memory impairment, confused thinking, weakness, seizures, and balance problems.
Signs of bleeding such as vomiting or coughing up blood; vomiting like coffee grounds; blood in the urine; black, red, or tarry stools; bleeding from the gums; non-cyclic vaginal bleeding; bruising that occurs or increases for no reason; bleeding that you cannot stop.
Symptoms of a severe skin reaction (Stevens-Johnson syndrome / toxic epidermal necrolysis) such as redness, swelling, blistering or scaling of the skin (with or without fever), redness or irritation of the eyes, ulcers in the mouth, pharynx, nose or eyes.
Convulsions.
Inability to control the bladder.
Significant weight gain or loss.
Sexual problems such as decreased sex drive or ejaculation problems.
Liver problems have rarely happened with this drug. Sometimes these cases were fatal. Call your doctor right away if you have signs of liver problems such as dark urine, tiredness, lack of appetite, nausea or abdominal pain, discolored stools, vomiting, yellowing of the skin or eyes.
Some type of heart rhythm disorder (long QT interval) has happened with this drug.Sometimes it caused another type of heart rhythm disturbance (polymorphic ventricular tachycardia of the “pirouette” type). See your doctor right away if you have tachycardia, irregular heartbeats, or fainting.

What are some other side effects of this drug?

Any medicine can have side effects. However, many people have little or no side effects. Call your doctor or get medical help if these or any other side effects bother you or do not go away:

Feeling dizzy, sleepy, tired, or weak.
Constipation, diarrhea, abdominal pain, nausea, vomiting, or decreased appetite.
Dry mouth.
Sleep disorders.
Excessive sweating.
Shiver.

This list of potential side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Office.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your healthcare practitioner. Read all the information provided to you. Follow all instructions strictly.

Pills:

Take this medication with or without food.
Continue taking this drug as directed by your doctor or other healthcare professional, even if you feel well.

Capsules:

Take this drug with food.
Continue taking this drug as directed by your doctor or other healthcare professional, even if you feel well.

Liquid:

Use only the measuring container supplied with the liquid preparation.
Mix liquid with 120 ml of water, ginger ale, lemon soda, lemonade, or orange juice.
Take the dose immediately after mixing. Do not store for future use.
This drug may look cloudy after mixing. This is normal.
Continue taking this drug as directed by your doctor or other healthcare professional, even if you feel well.

What should I do if a dose of a drug is missed?

Take the missed dose as soon as you can.
If it is time for your next dose, do not take the missed dose and then return to your normal dose schedule.
Do not take 2 doses at the same time or an additional dose.

How do I store and / or discard this drug?

Store at room temperature.
The lid must be tightly closed.
Store in a dry place. Do not store in the bathroom.
Store all medicines in a safe place.Keep all medicines out of the reach of children and pets.
Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

General information on medicinal products

If your health does not improve or even worsens, see your doctor.
You should not give your medicine to anyone and take other people’s medicines.
Some medicines may have different patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
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instructions for use, analogs, composition, indications

Clinical trial data:

Nausea is the most common adverse reaction to sertraline treatment. In the treatment of social phobia, sexual dysfunction (problems with ejaculation) developed in 14% of men taking setraline, compared with 0% in the placebo group. These side effects were dose-dependent and often resolved with continued treatment.

The profile of side effects seen in double-blind, placebo-controlled trials with patients with OCD, panic disorder, PS, and social phobia was similar to those seen in clinical trials involving patients with depression.

Listed below are adverse reactions observed in the post-marketing period (frequency unknown) and during placebo-controlled clinical studies (2542 people who took sertraline, 2145 – placebo) in patients with depression, OCD, panic disorder, PS and social phobia.

The frequency was determined as follows: very often (> 1/10), often (from> 1/100 to <1/10), not often (from> 1/1000 to <1/100), rarely (from> 1 / 10,000 to 1/1000), very rare (<1/10000).

Infectious and parasitic diseases

Often: pharyngitis

Uncommon: upper respiratory tract infections, rhinitis Rare: diverticulitis, gastroenteritis, otitis media

Benign, malignant and unspecified neoplasms (including cysts and polyps)

Rare: neoplasm

Disorders of the CO side of the blood and lymphatic system

Frequency unknown: leukopenia, thrombocytopenia Immune system disorders

Frequency unknown: anaphylactoid reactions, allergic reactions, allergies Endocrine system disorders

Unknown frequency: hyperprolactinemia, hypothyroidism, antidiuretic hormone secretion disorder syndrome

Metabolic and nutritional disorders

Often: anorexia, increased appetite

Rare: hypercholesterolemia, hypoglycemia

Frequency unknown: hyponatremia, diabetes mellitus, hyperglycemia

Mental Disorders

Very common: insomnia (19%)

Often: depression, depersonalization, nightmares, anxiety, agitation, nervousness, decreased libido, bruxism

Uncommon: hallucinations, euphoria, apathy, impaired thinking

Rare: conversion disorder, drug dependence, mental disorder, violent reactions, paranoia, suicidal thoughts / suicidal behavior, sleepwalking, premature ejaculation Frequency unknown: painful dreams

Disorders from the nervous system

Very often: dizziness (11%), insomnia (13%), headache (21%)

Often: paresthesia, tremor, hypertension, dysgeusia, attention disorders

Uncommon: convulsions, involuntary muscle contraction, coordination disorders, hyperkinesia, amnesia, hyposthesia, speech disorders, postural dizziness, migraine Rarely: coma, choreoathetosis, dyskinesia, hyperesthesia, sensory disturbances Frequency unknown: movement disorders (including extrapyramidal symptoms such as , hypertension, teeth grinding or gait disturbances), syncope.Signs and symptoms associated with serotonin syndrome, in some cases with concomitant use of serotonergic drugs, were also noted: feelings of excitement, embarrassment, diaphoresis, diarrhea, fever, hypertension, rigidity and tachycardia. Akathisia and psychomotor instability

Violations of the organ of vision

Often: visual impairment

Rare: glaucoma, lacrimation disorders, scotoma, diplopia, photophobia, hyphema, mydriasis * Frequency unknown: abnormal vision

Hearing disorders and labyrinth disorders

Often: tinnitus

Uncommon: ear pain

Cardiac disorders

Often: palpitations

Uncommon: tachycardia

Vascular disorders

Uncommon: hypertension, hyperemia Rare: peripheral ischemia

Frequency unknown: abnormal bleeding (including epistaxis, gastrointestinal bleeding, or hematuria)

Disorders of the respiratory system, chest and mediastinal organs

Often: yawning

Uncommon: bronchospasm, dyspnea, epistaxis

Rare: laryngospasm, hyperventilation, hypoventilation, stridor, dysphonia, hiccups

Disorders from the gastrointestinal tract

Very common: diarrhea (18%), nausea (24%), dry mouth (14%)

Often: abdominal pain, vomiting, constipation, dyspepsia, flatulence

Uncommon: esophagitis, dysphagia, hemorrhoids, increased salivation, tongue diseases, belching Rarely: melena, bloody stools, stomatitis, ulcers on the tongue, dental diseases, glossitis, mouth ulcers Frequency unknown: pancreatitis

Disorders from the liver and biliary tract

Rare: liver dysfunction

Frequency unknown: serious liver disease (including hepatitis, jaundice and liver failure)

Skin and subcutaneous tissue disorders

Often: rash, hyperhidrosis

Uncommon: periorbital edema, pruritus, alopecia, cold sweat, dry skin, urticaria Rare: dermatitis, bullous dermatitis, follicular rash, abnormal hair texture, abnormal skin odor

Frequency unknown: rare cases of severe exfoliative skin disorders, e.g. Stevens-Johnson syndrome and epidermal necrosis, angioedema, facial edema, photosensitivity, skin reactions, pruritus

Musculoskeletal and connective tissue disorders

Often: myalgia

Uncommon: osteoarthritis, muscle weakness, back pain, muscle twitching Rare: bone disease

Frequency unknown: arthralgia, muscle spasms Renal and urinary tract disorders

Uncommon: nocturia, urinary retention, polyuria, pollakiuria, urinary disorders Rarely: oliguria, stress urinary incontinence, urinary retention

Genital and breast disorders

Very common: ejaculation disorders (14%)

Often: male sexual dysfunction, erectile dysfunction Uncommon: vaginal bleeding, female sexual dysfunction

Rare: menorrhagia, atrophic vulvovaginitis, balanoposthitis, genital secretion,

General disorders and disorders at the injection site

Very common: fatigue (10%)

Often: chest pain

Uncommon: malaise, chills, pyrexia, asthenia, thirst

Rare: Hernia, insertion site fibrosis, decreased drug tolerance, gait disturbances, non-measurable events Frequency unknown: peripheral edema

Influence on the results of laboratory and instrumental research

Uncommon: weight loss, weight gain

Rare: increased alanine aminotransferase, increased aspartate aminotransferase, abnormal sperm secretion

Frequency unknown: altered clinical laboratory test results, altered platelet counts, elevated serum cholesterol

Injuries, intoxication and complications of manipulations

Rare: trauma

Surgical and therapeutic procedures

Rare: procedure to dilate blood vessels

One case of neoplasm was reported for a patient taking sertraline, while no such case was reported in the placebo group.

* these adverse reactions were recorded in the post-marketing period

** the total number of patients in six groups was used for the calculation: sertraline – 1118 men and 1424 women, placebo – 926 men and 1219 women (for OCD studies were short-term (1-12 weeks))

♦♦♦ Cases of suicidal behavior and attempted suicide have been reported during treatment with sertraline or shortly after stopping it (see section Special instructions and precautions for use).

Withdrawal symptoms observed upon discontinuation of sertraline treatment

When discontinuing treatment with sertraline, patients often develop withdrawal symptoms, especially in the event of a sudden discontinuation (see sections Special instructions and precautions for use and Method of administration and dosage).

Elderly patients

Taking SSRIs or SNRIs, including sertraline, may cause hyponatremia in elderly patients, who are at increased risk of developing this adverse reaction (see.(See section Special instructions and precautions for use).

Pediatric and adolescent patients

When analyzing data from clinical studies obtained for 600 patients of childhood and adolescence who took sertraline, the profile of adverse reactions was generally similar to that for adult patients. The following adverse reactions have been reported in controlled clinical trials (n = 281 for patients taking sertraline):

Very common (> 1/10): headache (22%), insomnia (21%), diarrhea (11%) and nausea (15%).

Often (> 1/100 to <1/10): chest pain, mania, pyrexia, vomiting, anorexia, affective lability, aggression, agitation, nervousness, impaired attention, dizziness, hyperkinesia, migraine, drowsiness, tremor, disturbance h, nightmares, fatigue, stress urinary incontinence.

Nightmares, fatigue, stress urinary incontinence, bleeding, flatulence.

Uncommon (> 1/1000 to <1/100): prolonged QT interval on ECG, suicide attempt, convulsions, extrapyramidal disorder, paresthesia, depressive syndrome, hallucination, purpura, hyperventilation, anemia, liver dysfunction, elevated alanine aminotransferase levels cystitis, herpes simplex, otitis media, ear pain, eye pain, mydriasis, malaise, hematuria, pustular rash, rhinitis, trauma, weight loss, muscle twitching, nightmares, apathy, proteinuria, pollakiuria, polyuria, pain in breasts, menstrual irregularities, alopecia, dermatitis, skin inflammation, bad skin odor, urticaria, bruxism, hyperemia.

Frequency unknown: enuresis

Adverse reactions

Epidemiological studies conducted mainly on a group of patients aged 50 years and older have shown an increased risk of fractures in patients taking SSRIs and TCAs. The mechanism of this phenomenon is unknown.

90,000 Antidepressant Zoloft has disappeared from St. Petersburg pharmacies. Bumaga

The St. Petersburg branches of large drugstore chains temporarily lack the antidepressant Zoloft (INN sertraline).This “Paper” was confirmed in the reference services of “Petersburg Pharmacies”, “Ozerkov”, “Raduga”, “First Aid” and “Nevis”.

None of the inquiry services interviewed could explain why the antidepressant is not available in the pharmacy departments and when it will appear there.

A reader reported on the shortage of the drug “Paper” . According to her, two weeks ago she barely found the drug in one of the city’s pharmacies, and on March 25, her colleague could not do it. The reader noted that in some pharmacies in St. Petersburg she could not find analogues of the antidepressant.

On March 18, Pharmaceutical Bulletin wrote that Zoloft is difficult to find in online pharmacies in Moscow, Omsk, Nizhny Novgorod, Vladivostok and other cities. The company “Pharmacy Chain 36.6” confirmed the shortage of the drug. And the Pulse company said that the delivery was expected in the coming days.

Since mid-February 2020, sales of prescription antidepressants, including Zoloft, have increased in Russia, RBC wrote last year with reference to the analytical company DSM Group.According to analytical company Alpha RM, total sales of Zoloft in 2020 increased by 42% compared to 2019. And in January 2021, sales of this antidepressant grew by 35% compared to January last year.

In October 2020, in many regions of Russia there was a shortage of drugs for the treatment of ARVI, pneumonia and coronavirus. Then it was associated with the introduction of mandatory labeling of medicines from July 1.

In March 2021, the All-Russian Union of Patients asked the Federation Council to pay attention to failures in the implementation of one of the pharmaceutical programs.In their opinion, this can lead to a shortage of certain drugs.

In March, St. Petersburg also experienced a shortage of coronavirus vaccine due to a failure in the supply of the Ministry of Health, but later new batches of vaccinations were brought to the city.

Sertraline

Sertraline is a selective serotonin reuptake inhibitor drug used to treat depression and anxiety disorders.

Synonyms Russian

Aleval, Asentra, Deprefolt, Zoloft, Emoton, Seralin, Serenata, Surlift, Stimuloton, Torin, Adjuvin, Misol, Zalox, Lustral, Sertiva, Sertran, Setaloft.

English synonyms

Sertraline, Zoloft, Lustral, Daxid, Deprax, Altruline, Besitran, Eleval, Emergen, Gladem, Implicane, Sedoran, Sealdin, Serivo, Lowfin, Stimuloton, Serimel, Seretral, Tresleen, Sertralin Bluefish.

Research method

Gas chromatography-mass spectrometry (GC-MS).

Units

Ng / ml (nanogram per milliliter).

What kind of biomaterial can be used for research?

Venous blood.

How to properly prepare for the study?

Do not eat for 2-3 hours before the test, you can drink clean non-carbonated water.
Do not smoke within 30 minutes prior to examination.

General information about the study

Sertraline is an antidepressant from the group of selective serotonin reuptake inhibitors, which slightly affects the reuptake of norepinephrine and dopamine.The drug is indicated for the treatment of depression, anxiety, obsessive-compulsive and panic disorder, and post-traumatic stress disorder.

After oral administration, the drug is slowly but completely absorbed. The concentration of sertraline in the blood serum is proportional to the dose of the drug taken. The blood protein binding is 98%. The maximum concentration of sertraline in the blood is observed 4.5-8.4 hours after administration, depending on the dose of the drug. Sertraline is actively metabolized in the liver with the participation of cytochrome P450 isoenzyme 3A4 to a less active metabolite of N-desmethylsertraline, which is also transformed in the liver and then conjugated with glucuronic acid.The half-life of the drug is 26 hours, and its metabolite is 62-104 hours. About 40-45% of sertraline is excreted in the urine after 9 days. The same amount of the drug is excreted in the feces, and 12-14% of sertraline is excreted unchanged.

While taking sertraline, headache, fatigue, nausea, diarrhea, insomnia, dry mouth, tinnitus, and sexual dysfunction may occur.

Acute overdose of the drug is manifested by serotonin syndrome, nausea, vomiting, lethargy, ataxia, tachycardia, convulsions and requires immediate hospitalization.

Monitoring of drug concentration in blood is not indicated for all patients taking sertraline. It is recommended to determine the level of the drug in the blood if an overdose is suspected, as well as in patients with impaired liver and kidney function.

What is the research used for?

Monitoring of drug concentration in blood;
assessment of drug interactions;
diagnostics of overdose;
identification of violations of the regimen of taking the drug.

When is the study scheduled?

In case of suspicion of non-compliance by the patient with the regimen of taking the drug;
with persistence of symptoms or exacerbation of the disease while taking sertraline;
if the patient has impaired liver and kidney function;
when prescribing the drug to elderly people;
with the appearance of adverse events, probably associated with the intake of sertraline, and a suspicion of an overdose of the drug.

What do the results mean?

Reference values: 15 – 70 ng / ml.

What can influence the result?

Medicines that can increase the concentration of sertraline in the blood: diazepam, cimetidine.
An increase in the concentration of the drug in the blood is possible in case of impaired liver and kidney function, in the elderly.

Download an example of the result

Important notes

Treatment, dose adjustment of this drug and monitoring of concentration are carried out strictly under the supervision of a physician.It is unacceptable to independently change the regimen and dose of the drug.
During the period of taking the drug, it is recommended to periodically monitor the level of glucose and electrolytes in the blood.

Also recommended

[02-014] Complete blood count

[06-003] Alanine aminotransferase (ALT)

[06-010] Aspartate aminotransferase (AST)

[06-015] Plasma glucose

[06-065] Sodium in serum

[06-064] Potassium in serum

[06-021] Serum creatinine

[18-084] Cytochrome P450 2C19.Genotyping by marker CYP2C19 G681A

Who orders the study?

Psychiatrist, psychotherapist, clinical pharmacologist.

Literature

Brunton L, Chabner B, Knollman B. Goodman and Gilman’s The Pharmacological Basis of Therapeutics, Twelfth Edition. McGraw Hill Professional; 2010.

The computer has learned to predict the effectiveness of an antidepressant by EEG

Amit Etkin et al./ Nature Biotechnology, 2020

American scientists have developed an algorithm that can predict the effectiveness of the course of the antidepressant sertraline based on brain activity at rest.To do this, they trained a regression model on the EEG of 309 patients, half of whom were prescribed a course of the drug, and half a placebo. It turns out that activity at rest with eyes open in the alpha range is the best predictor of treatment efficacy – and it can also be used to test other therapies, such as magnetic stimulation. Article published at Nature Biotechnology .

At the molecular level, depression is a lack of neurotransmitters from the monoamine group, which are primarily responsible for the transmission of an electrical signal in the brain’s reward system: serotonin, dopamine and norepinephrine.In most cases, drugs from the group of selective serotonin reuptake inhibitors are used to treat depression: they showed their effectiveness back in the middle of the last century.

Nevertheless, there are a lot of drugs in this group, and they differ in different additional effects, for example, anti-anxiety. Due to the fact that it is rather difficult to assess all additional symptoms and find the right medicine, the effectiveness of antidepressants is often, even in clinical trials, not very high (namely, not higher than placebo): simply because the drug is not suitable.

That is why, in order for the treatment to have at least some effect, it is better to know in advance whether the drug will work. One way is to study the effect of the drug on the brain: for example, at the end of last year, scientists were able to predict the effectiveness of several different antidepressants on brain connections.

At the same time, it seems more meaningful to assess the effect of treatment on brain activity, at least in the short term: patterns of brain activity should respond to treatment faster than its connections.Scientists led by Amit Etkin from Stanford University decided to evaluate the effectiveness of antidepressants using EEG at rest.

Their study involved 309 people diagnosed with depression. The participants were divided into two groups: the first took a course of the antidepressant sertraline (also known as Zoloft) for eight weeks, and the second a placebo. Before the start of the course, the scientists took measurements of brain activity at rest – with eyes closed and open.At the end of the course, the effectiveness of treatment was assessed using the Hamilton scale, comparing with the indicators before the start of treatment.

Scientists focused on the activity of the prefrontal and parietal areas of the brain and trained on the data obtained an algorithm based on linear regression – it allowed to identify the relationship between the effectiveness of treatment and brain activity at rest. For prediction, activity was used in four main ranges: theta (4 to 7 hertz), alpha (8 to 12 hertz), beta (13 to 30 hertz), and gamma (30 to 51 hertz).

For the sertraline group, treatment efficacy was best predicted by activity in the alpha range at rest with eyes open (p <0.0001), but placebo efficacy could not be determined. At the same time, the algorithm did not find any relationship with the activity and severity of symptoms of depression at the initial diagnosis.

The algorithm was then tested on two additional independent patient samples (24 and 72 subjects), and the efficacy of sertraline treatment was also predicted prior to initiation of EEG treatment.The researchers then used data from 152 patients who were treated with transcranial magnetic stimulation for depression: it turned out that the algorithm could also predict the effectiveness of a course of stimulation of the dorsolateral part of the prefrontal cortex.

Scientists, thus, managed not only to develop a fairly simple method for analyzing the effectiveness of antidepressants, but also to point out a separate neural mechanism – activity in the alpha range at rest – by which other methods of treating depression can be evaluated.

The effectiveness of another common treatment for depression, psychotherapy, can also be measured by EEG: moreover, the way the brain reacts to receiving rewards can even predict whether psychotherapy or antidepressants will work better. American psychologists learned how to do this two years ago.

Elizaveta Ivtushok

Antidepressant Zoloft in the practice of a physician-therapist

Antidepressant Zoloft in the practice of a general practitioner The work of a doctor of any profile has its own characteristics.The specificity of the work of a general practitioner is determined by a wide range of his diagnostic and therapeutic activities, sometimes without clear boundaries. In the diagnosis and treatment of diseases of the cardiovascular system, the therapist interacts (collaborates, and sometimes competes) with a cardiologist, in the treatment of diseases of the digestive system – with a gastroenterologist, in the treatment of kidney diseases – with a nephrologist and urologist, etc. Therapists, along with traumatologists and rheumatologists quite often deal with the treatment of patients with osteochondrosis, arthrosis and arthritis.It is the therapist who can be the main physician for patients with several concomitant diseases, since he has to put into practice the principle of “treating not a disease, but a patient” and sometimes drawing up a final comprehensive treatment plan, taking into account the prescriptions of narrow specialists.

Quite rightly, the therapist is called the “primary link” of the health care system and the “family doctor”, since he has to deal with the issues of primary diagnosis and treatment of many diseases.Many patients, regardless of the pathology detected, remain under his supervision, and the treatment of the rest (referred to narrow specialists) can subsequently be carried out with his participation. And of course, for each patient, the therapist should ideally be a personal psychotherapist.
In his work, the therapist is often faced with one or another manifestation of depression, which is revealed in many patients with a therapeutic profile. According to statistics, 80% of all patients with depressive disorders primarily turn to a therapist, which is due to both objective and subjective reasons.Among the objective reasons, one can single out the mutual influence of the pathogenetic mechanisms of mental disorders and organic diseases (including internal diseases).

On the one hand, depression can create conditions for the formation of organic diseases, aggravate and change their course. This is mediated through many neuroendocrine and immunological mechanisms, about the interaction of which there is currently no consensus. However, it is believed that they are realized through significant violations of vegetative functions, which causes the formation of “organ neuroses”.Pathological intensification of sympathoadrenal influences may be accompanied by the formation of persistent arterial hypertension, hyperthyroidism, decreased glucose tolerance, and an increase in the content of inflammatory enzymes in the synovial fluid.

Parasympathetic pathological influences contribute to the formation of bronchospastic syndrome and hypersecretion of gastric juice.
On the other hand, the pathogenesis of long-term chronic somatic diseases presupposes the formation of certain psychological changes that create preconditions for the development of depression.The so-called psychosomatic disorders include not only organ neuroses (syndrome of “irritable stomach”, “irritable bowel”, “irritated bladder” and other “irritated” organs, functional coprostasis, achalasia of the esophagus), but also conditionally reflexive attacks of angina pectoris , bronchospasm, etc. Such disorders are often accompanied by phobias (fear of gas incontinence, inability to use the toilet) and psychoactive states (neurotic syndromes, affective and pathocharacterological reactions).

Thus, one group of patients with depression at the reception of a therapist consists of “dispensary” patients who have developed new symptoms, and the other – new patients who have turned to a therapist with somatic manifestations of depression.
It should be noted that in these difficult conditions, timely diagnosis of depressive disorders largely depends on the qualifications of the doctor: the appearance of somatic symptoms in a patient with depression is often mistakenly perceived as autonomic manifestations of psychogenic disorders, and the attachment of symptoms of depression to the clinic of a somatic disease – as astheno-vegetative or ” hypochondriacal syndrome (as part of the clinic of the underlying disease).

The diagnostic principle of searching for one disease that explains the full completeness of the symptoms in a particular patient (correct in most cases) often plays a cruel joke with the doctor when diagnosing depression. In addition, the primary appearance of depressive symptoms or its addition to somatic pathology significantly reduces the patient’s adherence to treatment.
As for the subjective reasons for such a high frequency of patients with depression referring to a therapist, it can be noted that a significant part of patients, even guessing about the nature of their condition, under the influence of subjective factors, prefer to seek help not from a psychiatrist (some are afraid of publicizing the fact of observation by a psychiatrist and associated social constraints, others – the alleged negative side effects of psychotropic drugs).

The specificity of the medical activity of a general practitioner determines the peculiarities of the choice of drugs. As their own observations show, therapists prefer to start treatment with broad-spectrum drugs with a proven therapeutic effect, without pronounced side effects and adverse interactions with other drugs that have a positive effect on the most common concomitant pathology that have a convenient regimen of administration – then there are first-line drugs that are safe and effective in most patients.So, in the treatment of arterial hypertension, we often begin therapy with the use of modern calcium antagonists (amlodipine) or angiotensin-converting enzyme inhibitors (quinapril, lisinopril). When choosing antibiotic therapy, we often start treatment with broad-spectrum antibiotics. Selective serotonin reuptake inhibitors (SSRIs), in particular sertraline (Zoloft, “Faizer”), occupy such a place for the treatment of depressive conditions in the arsenal of a general practitioner.

As a characteristic representative of the SSRI group, Zoloft has all the main advantages of this group of antidepressants.SSRIs differ from other drugs used in the treatment of depressive conditions in fewer and less severity of side effects. They do not increase the effects of alcohol and tranquilizers when taken simultaneously. The drugs of this group, in contrast to sulpiride, do not affect the level of prolactin.
If you look at the list of side effects of SSRIs, then it becomes uncomfortable (for both the doctor and the patient): anxiety, disturbances in sleep, vision, gait, indigestion, sexual function and organs of the endocrine system are possible.However, in our clinical practice, only the parasympathicotonic effects of SSRIs were encountered: sweating, hypotension and dizziness, dry mouth, and the frequency of these effects was rather low.

Indications for the appointment of Zoloft are depression (including accompanied by a feeling of anxiety) with or without a history of mania; obsessive-compulsive disorder (OCD) in adults and children; panic disorder with or without agoraphobia; post-traumatic stress disorder; social phobia (social anxiety disorder).With a satisfactory result of treatment, continuation of sertraline therapy is an effective means of preventing recurrence of the initial episode of depression and its development in the future; relapse of the initial episode of obsessive-compulsive disorder; panic disorder, initial episode of post-traumatic stress disorder, social phobia.

Sertraline does not cause drug dependence; does not have the stimulating and disturbing effects characteristic of D-amphetamine, or the sedative and psychomotor disturbances characteristic of alprazolam; does not have a stimulating, sedative or anticholinergic effect, and also does not show a cardiotoxic effect in the experiment.A wide range of indications and significant therapeutic capabilities, high and predictable efficacy, ease of administration (administration and control), low frequency of side effects determine the choice of Zoloft as a treatment for depression, as well as concomitant psychogenic and autonomic disorders in general therapeutic practice.

Medical newspaper “Zdorov’ya Ukrainy 21 storichchia” No. 3 (232), lutiy 2010 p.

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