SSRIs Sertraline

With regard to its effects on cognitive performance in the target population, the SSRI sertraline appears to be the most thoroughly studied newer antidepressant. Lane and O Hanlon (1999) listed three controlled clinical studies with fluoxetine and three with sertraline however, all three trials with fluoxetine and one of the trials with sertraline were not sufficiently powered to demonstrate reliable differences between treatments. One of the two adequately powered studies, a comparison between nortriptyline and sertraline in elderly depressed patients (Bondareff et al., 2000 see Box 7.3), supports the notion that antidepressants with anticholinergic action (such as nortriptyline) are similarly... 

In a double-blind, parallel-group study, Bondareff et id. (2000) compared the SSRI sertraline and the tricyclic compound nortriptyline with regard to their efficacy and safety in a group of 210 outpatients 60 years and older. The patients met the DSM-DI-R criteria for major depressive episode and had a minimum score of 18 on the Hamilton Rating Scale for Depression. Their mean age was about 68 years, most patients were white and about 60% were female the severity of depression was rated as moderate in more than 70% and as severe in more than 20% of the cases. The daily doses of sertraline were between 50 and 150 mg, and those of nortriptyline were 25 100 mg the treatment lasted 12 weeks. In addition to clinical rating scales and self-assessment instruments, patients took the following tests of cognitive performance ... 

Serotonin and dopamine reuptake inhibition. Dual reuptake blockers of both serotonin and dopamine are in clinical testing. Although the SSRI sertraline has some dopamine reuptake inhibition as well as more potent serotonin reuptake inhibition, minaprine and bazinaprine have more potent dopamine actions and are thus dual sero-tonin/dopamine agents. 

AMIODARONE SSRIs-SERTRALINE Sertraline may t amiodarone levels Sertraline may inhibit CYP3A4-mediated metabolism of amiodarone Watch for amiodarone toxicity for those taking high doses of amiodarone, consider using an alternative SSRI with a lower affinity for CYP3A4... 

Patients who are sensitive to the prolactin-elevating properties of other SSRis (sertraline is the one SSRI that generally does not elevate prolactin)... 

Like other SSRIs, sertraline should not be used within 2 weeks of discontinuing monoamine oxidase inhibitors (MAOIs) and MAOIs should not be started for at least 2 weeks after stopping sertraline. 

I The SSRIs sertraline and fluvoxamine have both been demonstrated to be safe and effective treatments for paediatric OCD and are licensed for use in children and adolescents in the UK. 

SSRI Sertraline (Zoloft) 50- 200mg/d none very low none very high very high moder- ate... 

Sertraline has been found to produce small increases in the free fraction of warfarin and a modest (-9%) increase in prothrombin time, which are considered clinically insignificant. Of the SSRIs, sertraline is assumed to exert the... 

The affinity data for the SSRIs show that the SSRIs, as a group, are very potent and selective inhibitors for SERT compared with their affinity for NE and dopamine reuptake transporters (Fig. 21.6) and are more potent inhibitors of 5-HT reuptake than are the tertiary amine TCAs, with the exoeption of clomipramine. None of the SSRIs has substantial effeot on the NET or dopamine transporter. Of the SSRIs, sertraline exhibits the most potent inhibition of dopamine reuptake transporter, although it is still 100 times less potent in terms of inhibiting the dopamine versus the SERT. Therefore, the plasma oonoentration of sertraline would have to be increased by as much as 100 times to inhibit the dopamine reuptake transporter. When drugs are this selective for the reuptake transporters, differences in potency become olinioally irrelevant, because the plasma concentration oan be dose-adjusted to achieve inhibition of the desired transporter without affecting the other transporters. Clomipramine displays less affinity for SERT than oitalopram, fluvoxamine, paroxetine, or sertraline does and is more potent than fluoxetine. In terms of the ability to inhibit the NET, the SSRIs are two to three times less potent than the SNRI TCA, desipramine. 

The client diagnosed with obsessive-compulsive disorder is prescribed the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft). Which statement indicates the client understands the medication teaching ... 

Administer the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft). 

A second large class of agents known to form mechanism-based quasi-irreversible P450-MI complex es [15, 24, 25, 138, 139, 223-228] includes alkyl and aromatic amines, such as the monoamine oxidase inhibitor cloigyhne [223], the SSRI sertraline [228], and many clinically useful macrolide antibiotics such as troleando-mycin (TAO), clarithromycin, and erythromycin (Fig. 5.6 [229-235]). These amines are oxidized... 

Moreover, while a secondary amine such as the SSRI sertraline is capable of being N-demethylated by mrrltiple hepatic P450 isoforms (such as CYP2B6, CYP2C9, CYP2C19,... 

Therapeutic profile As a selective serotonin reuptake inhibitor (SSRI), sertraline is a widely used drug for the treatment of depression and anxiety-related disorders. 

Placebo-controlled trial T3 has been used to enhance the effects of antidepressant drugs but results have been mixed (SEDA-32, 764 SEDA-33,882). Results of the largest prospective placebo-controlled trial to date indicate that T3 does not augment the effects of the SSRI, sertraline in the treatment of recent-onset major depressive disorder (MDD) [14 ]. 

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