• Wednesday April 8,2020

sertraline

The drug sertraline is one of the selective serotonin reuptake inhibitors (SSRIs). These are used primarily for the treatment of depression.

What is Sertraline?

The drug sertraline is one of the selective serotonin reuptake inhibitors (SSRIs). These are used primarily for the treatment of depression.

The antidepressant sertraline belongs to the selective serotonin reuptake inhibitors, as are the antidepressants citalopram and fluoxetine. These influence the neurotransmitter household and have a mood-enhancing effect. Therefore, the drug sertraline is used inter alia for the treatment of anxiety disorders, obsessive-compulsive disorder and post-traumatic stress disorder (PTSD).

Like the other selective serotonin reuptake inhibitors, sertraline can cause various side effects. Particularly dreaded is the serotonin syndrome, which may occur with concomitant use of various serotonergic drugs or in the overdose of sertraline.

Pharmacological action

Sertraline exerts its effect in the synaptic cleft in the central nervous system. The synaptic cleft lies between a nerve cell and a downstream other (nerve) cell. Excitation is transmitted via the synaptic cleft. For this messenger substances, the so-called neurotransmitters, are needed.

Serotonin is one of these neurotransmitters. Among other things, the messenger substance acts in the central nervous system and is known for its mood-enhancing effect. Therefore, it is popularly known as the happiness hormone.

Many depression and anxiety disorders are probably due to a lack of serotonin. Selective serotonin reuptake inhibitors are designed to increase the concentration of serotonin in the synaptic cleft. Sertraline prevents the uptake of serotonin from the synaptic cleft into the surrounding cells. As a result, more serotonin remains in the gap, so that the serotonergic effect is enhanced. Already during the first intake of the drug unfolds its drive-enhancing effect. During the next one to three weeks this effect intensifies and manifests.

Medical application & use

Sertraline is used to treat major depression. In short-term use, the drug was clearly superior to placebo. This does not apply to all selective serotonin reuptake inhibitors.

Sertraline has also proved helpful in the treatment of obsessive-compulsive disorders and panic disorders. Although in patients with a social phobia the drug can also be used for therapy, it takes around six weeks to three months before the first treatment successes become visible.

Furthermore, the drug is widely used in the treatment of post-traumatic stress disorder. Again, however, a delayed treatment success is observed. Often, only after about three months an improvement. The more serious the symptoms, the longer it takes for patients to respond to the drug.

Risks & Side Effects

Side effects are quite common with sertraline. More than 10 percent of patients treated with sertraline suffer from insomnia, fatigue, dizziness and headache. Disorders of the gastrointestinal tract and dry mouth are also more frequently observed.

As with most selective serotonin reuptake inhibitors, sertraline can cause sexual dysfunction. For example, ejaculation failure and orgasm inability are commonly observed in men. As a rule, these sexual dysfunctions are reversible. However, there are also patients in whom the symptoms persist for several weeks or even months after discontinuation of the drug.

Common side effects include vomiting, profuse sweating, rash, and blurred vision. Also, hot flashes, urinary symptoms, heart palpitations and chest pain are observed. Although hallucinations, liver failure, coma, psychosis and Stevens-Johnson syndrome occur more often in association with sertraline, a causal relationship has not yet been established.

In manic or hypomanic patients special care is required. In some test patients, the manic symptoms increased during the intake of seratralin. Occasionally, however, it also leads to exaggerated euphoria, depression or hallucinations.

Studies have also shown that suicidal behavior is promoted in children and adolescents. Children and adolescents are more likely to have suicidal thoughts than children and adolescents receiving other medicines. Increased hostility with increased aggression can also be observed. These side effects are rare in adults.

A rather rare but dangerous side effect is serotonin syndrome. This occurs especially when sertraline is combined with other centrally acting medications. These include medicines for depression (eg, lithium or St. John's wort), triptan-type migraines, and tryptophan. Serotonin syndrome is characterized by muscle tremors, high fever, loss of consciousness and muscle stiffness.

Because MAO inhibitors potentiate the serotonergic effects of sertraline, they must not be co-administered with the selective serotonin reuptake inhibitor. Also, alcohol should be avoided while taking. Equally undesirable is the combination of sertraline with phenytoin and platelet aggregation inhibitors. Further, sertraline may also affect the effect of coumarins (vitamin K antagonists).

Sertraline should not be stopped suddenly. If the drug is discontinued too quickly and not excreted, the patients may experience anxiety, dizziness, agitation, headache, tremors, nausea and sweating. Although the symptoms resolve within 14 days, it may take several months for all adverse drug reactions to disappear.

Women of childbearing potential should only take the active substance sertraline with adequate contraception. The drug passes through the placenta and the umbilical cord into the child's organism. Although no adverse health effects of the drug on the unborn child have been found, but damage can not be ruled out. Breastfeeding mothers should also refrain from using sertralin while breastfeeding.

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