Sertraline

Brand Name:

Zoloft

Drug Class:

Selective Serotonin Reuptake Inhibitor

How it works:

Boosts the effects of a neurotransmitter found in the brain called Serotonin. Also boosts Dopamine through Dopamine Transporter (DAT) Inhibition. Finally, Sertraline binds to sigma 1.

What makes it unique: 

The mild Dopamine increase (think very, very small amount of stimulant effect) may increase low energy. The sigma 1 actions are not completely understood but may help in treating anxiety or psychotic depression.

Side effects:

Headaches and stomach aches are common when starting, but then often goes away. Sexual dysfunction can also occur. Increased serotonin can cause diminished dopamine release, which may lead to emotional flattening and apathy in some patients. Sertraline may cause insomnia, sedation, or agitation.

Rare side effects include hyptension (low blood pressure), hyponatremia, seizures, induction of mania, and activation of suicidal ideation in people age 24 and younger.

How effective is it:

Plenty of studies show efficacy.
(1) There was a large analysis of 4,732 patients on Sertraline compared to 4,571 patients on another antidepressant. This analysis showed a trend in favor of Sertraline over other antidepressants.

(2) In a 1995 study, a scale used to measure symptoms of depression called HAM-D was analyzed. Different doses of Sertraline were compared to placebo. The HAM-D score decreased by 45.5% in the Sertraline 50mg group, by 45.9% in the 100mg group, and by 50.1% in the 200mg group. The placebo group lagged behind with a decrease of 34.6%.

Clinical experience:

Sertraline can be helpful in patients with anxiety and depression. It is a very common antidepressant, and most prescribers feel comfortable using it. It may be best to take in the morning due to the small amount of energizing effect from the Dopamine. Pharmaceuticals should never be used as the sole treatment for mental illnesses. Therapy, exercise, meditation or other treatments should always accompany prescriptions.

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References:

1. Cipriani A, La Ferla T, Furukawa T et al. Sertraline versus other antidepressive agents for depression. Cochrane Database Syst Rev. 2010 Apr 14;(4).

2. Fabre LF, Abuzzahab FS, Amin M, et al. Sertraline safety and efficacy in major depression: a double-blind fixed-dose comparison with placebo. Biol Psychiatry. 1995 Nov 1;38(9):592-602.