Sertraline indications

Differentiating between depression and dementia can be difficult, so symptoms of depression should be documented for several weeks prior to initiating therapy for the treatment of depression with AD. Citalopram and sertraline are recommended as first-line agents because of their efficacy in placebo-controlled trials.49 Indications for the use of antidepressants include depression characterized by poor appetite, insomnia, hopelessness, anhedonia, withdrawal, suicidal thoughts, and agitation. 

An initial controlled study of venlafaxine, a SNRI, indicated that it is as effective as sertraline for overall PTSD symptoms at a mean dose of approximately 225mg/day. 

The prototypical serotonin reuptake inhibitor (SRI) medication is the non-selective agent clomipramine, a tricyclic antidepressant (TCA). The Selective SRIs (SSRIs) include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), and citalo-pram (Celexa). The Food and Drug Administration (FDA) approved clinical indications for these medications are described in Table 22.1. 

In general, one of the advantages of the SSRIs is that electrocardiographic (EKG) monitoring is not required. Eew, if any, cardiac adverse events are reported on SSRI monotherapy. Recently, Wilens and colleagues (1999) reported that there were no changes in EKG indices or vital signs in children and adolescents on sertraline at doses up to 200 mg/day. 

The SSRIs are considered broad-spectrum agents in the treatment of PTSD. In a seminal study leading to sertraline s FDA indication for the treatment of adult PTSD, Brady et al. (2000) demonstrated effectiveness over placebo in 94 subjects treated with sertraline (versus 93 with placebo) in three of four primary outcome measures. 

Clomipramine, fluvoxamine, and sertraline labeling all describe positive results of trials of these drugs in pediatric patients with OCD, in effect, granting an indication for these drugs in pediatric OCD. 

In four instances, the agency has invoked this rule at the time of approval of supplements for new indications for psychotropic drugs already approved for other psychiatric indications. It was noted in the approval letters for these supplements that, since the drugs in question would likely be used in children and/ or adolescents with the newly approved indications, the FDA required the sponsors of these products to conduct studies that would be pertinent to such use in the pediatric population. Since the products were ready for approval in adults, the FDA deferred the required pediatric studies to a future date. Alternatively, sponsors could make an argument for waiver of the requirement. The drug products and indications for which the FDA has required studies under the Pediatric Rule are as follows paroxetine for social anxiety disorder sertraline for post-traumatic stress disorder (PTSD) olanzapine for acute mania in bipolar disorder and fluoxetine in premenstrual dysphoric disorder (PMDD). 

In the antipressant group, 92.1% were treated with a SSRI, most commonly citalopram (47.9%) or sertraline (29.3%). The indications for prescribing antidepressants were depression in 59.2%, OCD in 29.8%, anxiety disorder in 10.7%, and eating disorder in 6.3% of those treated with an antidepressant (Sorensen et al. 2002, in press). Of the total population of 0 to 8-year-... 

Some evidence indicates that social phobia responds to SSRls, and case reports and studies with fluoxetine [B. Black et al. 1992 Van Ameringen et al. 1993), fluvoxamine [Mendels et al. 1995), paroxetine [Pitts et al. 1996 Ringold 1994), and sertraline [Katzelnick et al. 1995) have reported positive results. Although the full details of these studies have not been published, it seems that SSRls might well prove, in due course, to be effective treatments for social phobia. At the moment, the only treatment licensed for social phobia is moclobemide, which is a reversible inhibitor of monoamine oxidase-A [Nutt and Montgomery 1996 Versiani et al. 1992), and it is possible that it... 

Treatment of psychiatric complications should generally be along standard lines for the respective conditions. Some syndromes appear to be brief and self-limiting once ecstasy use stops, but a more chronic course may also be seen, with cases in the literature of psychoses which prove resistant to treatment (Vecellio et al. 2003). Whichever psychiatric syndrome occurs, there is possibly a theoretical indication for specific serotonergic re-uptake inhibitors such as fluoxetine, sertraline or citalopram, given the effect of ecstasy in reducing serotonin transmission. This would purely be a pragmatic approach which has not yet been properly tested, and it may be that the transmission abnormalities are not amenable to this kind of enhancement. 

Zimelidine was the first serotonin reuptake inhibitor available for clinical use, but in 1982 was withdrawn worldwide because of its toxicity ( 110). Despite this initial setback, five members of this class have been marketed in the United States and various countries around the world citalopram (Celexa), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). All except fluvoxamine have marketed indications in the United States for the treatment of major depression. Fluvoxamine is marketed in the United States for the treatment of obsessive-compulsive disorder rather than major depression, although it is marketed in a number of other countries for major depression. 

All SSRIs have an antipanic effect. Their advantages are limited adverse effects and lack of toxicity. Because of more acceptable adverse effect profiles, the SSRIs are usually the drugs of choice. Several studies consistently indicate that SSRIs such as fluoxetine, sertraline, paroxetine, fluvoxamine, as well as agents such as clomipramine and trazodone, all possess antipanic efficacy, although the last may be less effective than imipramine ( 24, 105, 106, 107, 108 and 109). 

The selective serotonin reuptake inhibitors (SSRIs) represent a chemically diverse class of agents that have as their primary action the inhibition of the serotonin transporter (SERT) (Figure 30-3). Fluoxetine was introduced in the United States in 1988 and quickly became one of the most commonly prescribed medications in medical practice. The development of fluoxetine emerged out of the search for chemicals that had high affinity for monoamine receptors but lacked the affinity for histamine, acetylcholine, and adrenoceptors that is seen with the tricyclic antidepressants (TCAs). There are currently six available SSRIs, and they are the most common antidepressants in clinical use. In addition to their use in major depression, SSRIs have indications in GAD, PTSD, OCD, panic disorder, PMDD, and bulimia. Fluoxetine, sertraline, and citalopram exist as isomers and are formulated in the racemic forms, whereas paroxetine and fluvoxamine are not optically active. Escitalopram is the S enantiomer of citalopram. As with all antidepressants,... 

Approximately 5% of women in the child-bearing years will have prominent mood and physical symptoms during the late luteal phase of almost every cycle these may include anxiety, depressed mood, irritability, insomnia, fatigue, and a variety of other physical symptoms. These symptoms are more severe than those typically seen in premenstrual syndrome (PMS) and can be quite disruptive to vocational and interpersonal activities. The SSRIs are known to be beneficial to many women with PMDD, and fluoxetine and sertraline have been approved for this indication. Treating for 2 weeks out of the month in the luteal phase may be as effective as continuous treatment. The rapid effects of SSRIs in PMDD may be associated with rapid increases in pregnenolone levels. 

The earliest and unfortunately still one of the commonest treatments of social phobia is self-medication with alcohol. The behaviorally disinhibiting actions of alcohol allow many social phobics to engage in social contacts that would otherwise be impossible. Legitimate therapeutic drugs for social phobia are now being discovered at a fast pace (Fig. 9—7). In fact, one of the SSRIs (paroxetine) already has been formally approved for use in the treatment of social phobia, and several other SSRIs and antidepressants are rapidly accumulating evidence of their efficacies in this condition as well. Specifically, studies of all five SSRIs (paroxetine, fluvoxamine, fluoxetine, sertraline, and citalopram) have indicated their efficacy in social phobia. Currently, SSRIs are considered first-line treatments for social phobia. 

Fluoxetine (Prozac /Lilly), paroxetine (Paxil /GlaxoSmithKilne), and sertraline (Zoloft /Pfizer) are selective serotonin reuptake inhibitors (SSRIs) and are useful in the treatment of depression. These agents potentiate the pharmacological actions of the neurotransmitter serotonin by preventing its reuptake at presynaptic neuronal membranes. In addition to its SSRI properties, venlafaxine (EfFexor /Wyeth-Ayerst) also appears to be a potent inhibitor of neuronal norepinephrine reuptake and a weak inhibitor of dopamine reuptake thereby enhancing the actions of these neurotransmitters as well. Venlafaxine is indicated for use in anxiety and depression. 

Treatment of icteric episodes with phenobarbital (3 x 20-60 mg/day) together with phototherapy (430-470 nm, 8-12 hr/day) and/or plasmapheresis is indicated. Cholestyramine (3x4 g/day) or cholestipol (3x5 g/day) may be used to treat pruritus. Qther recommended effective antipruritics are naloxone (2-3 x 0.4 mg/day, i.v.) or naltrexone (2-4 x 25-50 mg/day), which act as opi-oidergic neurotransmitters. (69) It is also possible to use the 5-HT3 antagonist ondansetron (3 x 4.8 mg/day, i.v. or orally). (64) Refractory cholestasis pruritus has recently been treated successfully with dronabinol (50) and also with sertraline. Administration of ursodeoxycholic acid (22, 53), medium-chain fatty acids, PUFA (65) and fat-soluble vitamins (especially vitamin K) is recommended. (s. pp 6, 47) (s. tab. 13.11)... 

Carbamazepine Some, but not all, reports indicate that carbamazepine serum levels can be increased by fluoxetine and fluvoxamine. Toxicity may develop. Sertraline normally appears not to affect carbamazepine, but sertraline levels may be reduced by carbamazepine. Isolated cases of Par-kinson-like and serotonin syndrome have occurred with fluoxetine and carbamazepine, while an isolated case of pancytopenia has been reported with sertraline and carbamazepine. The metabolism of citalopram may be increased. 

There are few controlled clinical trials of drugs in children and adolescents with GAD. CBT alone or in conjunction with antidepressants can have long-term benefits. Randomized controlled trials of sertraline and fluovoxamine, and open trials of alprazolam, clonazepam, and fluoxetine indicate short-term efficacy however, be-... 

The results of two long-term trials indicate that sertraline (12 months) and fluoxetine (9 months) were effective in preventing relapse. Sertraline also improved QOL compared with placebo. ... 

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