Sertraline long-term effects

The British medical journal, Lancet, recently published a meta-analysis (systemic review of research articles) that looked at the long-term effects of severely depressed patients taking the SSRI Zoloft (sertraline). Most patients not only felt much better after short-term antidepressant therapy but were able to function better, a surprising result considering the seriousness of the illness. A majority of those polled were much improved in just six to twelve weeks however, they tended to lose their psychosocial gains after discontinuing their medication. Overall, 70 percent of patients who discontinued SSRIs relapsed, compared to 40 percent of those who... 

These data confirm that the infants of nursing mothers taking SSRIs are likely to be exposed to low doses of antidepressants. While this rarely causes overt effects, the possibility of subtle long-term behavioral consequences cannot be excluded. In the case of sertraline it would be wise to discard breast milk accumulated 8-9 hours after dosing as this will reduce the daily dose that the infant receives. 

The diversity of the SSRIs is evident not only in their chemical structures, but also in their pharmacokinetic profiles. Fluoxetine has an elimination half-fife of 2 to 3 days (4 to 5 days with multiple dosing). The single-dose hah-hfe of norfluoxetine, the active metabolite, is 7 to 9 days. Paroxetine and sertrahne have half-lives of approximately 24 hours. Unlike paroxetine, sertraline has an active metabolite, but the metabohte contributes minimally to the pharmacologic effects. Escitalopram has a half-life of approximately 30 hours. Peak plasma concentrations of citalopram are observed within 2 to 4 hours after dosing, and the elimination half-life is about 30 hours. The SSRIs, with the exception of fluvoxamine, escitalopram, and citalopram, are extensively bound to plasma proteins (94% to 99%). The SSRIs are extensively distributed to the tissues, and aU, with the possible exception of citalopram, may have a nonlinear pattern of drug accumulation with long-term administration. ... 

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. ... 

Harel Z, Biro FM, Tedford WL. Effect of long term treatment with sertraline (Zoloft) simulating hypothyroidism in an adolescent. J Adolesc Health 1995 16 232-234. 

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