Sertraline (Zoloft) Medical Facts

Sertraline (Zoloft) in Brief

Active ingredient: Sertraline hydrochloride
Common brand names: Zoloft, Lustral, Sertranex, Apo-Sertral, Asentra, Gladem, Serlift, Stimuloton, Xydep, Serlain, Concorz
Drug class: Antidepressant, Selective Serotonin Reuptake Inhibitor
FDA Approved: 1991
Chemical Formula: C17H17Cl2N
Legal status: Prescription only
Pregnancy Category: C
Habit forming? No
Originally discovered: 1977s, Pfizer USA

FDA approved uses

Major Depressive Disorder
Obsessive-Compulsive Disorder
Panic Disorder
Posttraumatic Stress Disorder (PTSD)
Premenstrual Dysphoric Disorder (PMDD)
Social Anxiety Disorder

Off-label & Investigational uses

seasonal affective disorder (SAD) 6
general anxiety disorder 10, 11, 12
bulimia nervosa 14
binge eating disorder (BED) 19
premature ejaculation 2, 20, 21
fibromyalgia 13
bipolar depression 15
autistic spectrum disorders 17, 18
neurocardiogenic syncope 3
chronic fatigue syndrome 22
multiple sclerosis
irritable bowel syndrome (IBS)
ADD/ADHD

Seasonal affective disorder (SAD)
A placebo-controlled study has been shown that sertraline is an effective and well-tolerated therapy for SAD. The medication was well tolerated and the most frequent adverse events were nausea, diarrhea, insomnia and dry mouth.

General anxiety disorder
Sertraline appears to be effective and well tolerated in the treatment of generalized anxiety disorder. This medication demonstrated efficacy for both the psychic and somatic anxiety symptoms of GAD. Also, study have shown that sertraline may be safe and effective for the treatment of GAD in children and adolescents.

Bulimia nervosa (BN)
Studies show that antidepressants are efficacious in eating disorders. Randomized controlled trial confirms that sertraline is well tolerated and effective in reducing binge-eating crises and purging in patients with BN.

Binge eating disorder
Sertraline may be effective and well tolerated in the treatment of binge eating disorder. Sertraline has been shown to reduce the frequency of binges, clinical global severity, and body mass index.

Premature ejaculation
Sertraline appears to be a useful agent in the treatment of premature ejaculation. Studies have shown that sertraline therapy can cause significant prolongation of time to ejaculation.

Fibromyalgia
Sertraline may help diminish pain, morning stiffness and sleep disorders in fibromyalgia.

Chronic fatigue syndrome
One RCT compared sertraline with clomipramine in people with chronic fatigue syndrome.

Sertraline "pros" and "cons"

Advantages:

the only medication approved for the long-term treatment of PTSD
better tolerated than paroxetine for panic disorder
lower risk of weigt gain than with citalopram, fluvoxamine, and paroxetine 7
low potential for drug interactions at the level of the cytochrome P450 enzyme system 4
sertraline has advantages over paroxetine and fluoxetine in elderly patients because of it's comparatively low potential for drug interactions 4
minimal anticholinergic activity
does not impair vigilance performance 23
maintenance therapy with sertraline is well tolerated and effective for chronic depression 9

Disadvantages:

highest rate of diarrhoea than with other SSRIs 8

Time for Sertraline to clear out the system

Sertraline has half-life of about 26 hr. It may take 5 to 6 days to clear out of the system.

Weaning off Sertraline (Zoloft)

Zoloft has a half-life of about one day. That means that for every day that passes without taking the medication the level in the blood falls by 50%. After one day the level is reduced to 50% of the original level, after two days to 25%, after three days to 12.5%, and so on. When one stops Zoloft too rapidly a withdrawal syndrome may develop. While most people coming off Zoloft have no withdrawal symptoms, some people do have one or more.

Further reading

Sertraline (Zoloft) versus Other Medications

References

1. Physicians’ Desk Reference, 59th ed; Thomson PDR: Montvale, NJ; 2005.
2. McMahon CG. Treatment of premature ejaculation with sertraline hydrochloride. Int J Impot Res 1998;10:181-4. PubMed
3. Grubb BP, Samoil D, Kosinski D, Kip K, Brewster P. Use of sertraline hydrochloride in the treatment of refractory neurocardiogenic syncope in children and adolescents. J Am Coll Cardiol 1994;24:490-4.
4. Muijsers RB, Plosker GL, Noble S. Spotlight on sertraline in the management of major depressive disorder in elderly patients. Adis International Limited, Auckland, New Zealand. CNS Drugs 2002;16(11):789-94.
5. Murdoch D, McTavish D. Sertraline. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in depression and obsessive-compulsive disorder. Drugs. 1992 Oct;44(4):604-24. PubMed
6. Moscovitch A, Blashko CA, Eagles JM, Darcourt G, Thompson C, Kasper S, Lane RM; International Collaborative Group on Sertraline in the Treatment of Outpatients with Seasonal Affective Disorders. A placebo-controlled study of sertraline in the treatment of outpatients with seasonal affective disorder. Psychopharmacology (Berl). 2004 Feb;171(4):390-7. Epub 2003 Sep 19. PubMed
7. Maina G, Albert U, Salvi V, Bogetto F. Weight gain during long-term treatment of obsessive-compulsive disorder: a prospective comparison between serotonin reuptake inhibitors. J Clin Psychiatry. 2004 Oct;65(10):1365-71. PubMed
8. Meijer WE, Heerdink ER, van Eijk JT, Leufkens HG. Adverse events in users of sertraline: results from an observational study in psychiatric practice in The Netherlands. Pharmacoepidemiol Drug Saf. 2002;11:655–62. PubMed
9. Keller MB, Kocsis JH, Thase ME, Gelenberg AJ, Rush AJ, Koran L, Schatzberg A, Russell J, Hirschfeld R, Klein D, McCullough JP, Fawcett JA, Kornstein S, LaVange L, Harrison W. Maintenance phase efficacy of sertraline for chronic depression: a randomized controlled trial. JAMA. 1998 Nov 18;280(19):1665-72. PubMed
10. Allgulander C, Dahl AA, Austin C, Morris PL, Sogaard JA, Fayyad R, Kutcher SP, Clary CM. Efficacy of sertraline in a 12-week trial for generalized anxiety disorder. Am J Psychiatry. 2004 Sep;161(9):1642-9. PubMed
11. Rynn MA, Siqueland L, Rickels K. Placebo-controlled trial of sertraline in the treatment of children with generalized anxiety disorder. Am J Psychiatry. 2001 Dec;158(12):2008-14 PubMed
12. Dahl AA, Ravindran A, Allgulander C, Kutcher SP, Austin C, Burt T. Sertraline in generalized anxiety disorder: efficacy in treating the psychic and somatic anxiety factors. Acta Psychiatr Scand. 2005 Jun;111(6):429-35 PubMed
13. Gonzalez-Viejo MA, Avellanet M, Hernandez-Morcuende MI. A comparative study of fibromyalgia treatment: ultrasonography and physiotherapy versus sertraline treatment. Ann Readapt Med Phys. 2005 Nov;48(8):610-5. Epub 2005 May 31. PubMed
14. Milano W, Petrella C, Sabatino C, Capasso A. Treatment of bulimia nervosa with sertraline: a randomized controlled trial. Adv Ther. 2004 Jul-Aug;21(4):232-7.Click here to read. PubMed
15. Post RM, Altshuler LL, Leverich GS, Frye MA, Nolen WA, Kupka RW, Suppes T, McElroy S, Keck PE, Denicoff KD, Grunze H, Walden J, Kitchen CM, Mintz J. Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline. Br J Psychiatry. 2006 Aug;189:124-31. PubMed
17. Hellings JA, Kelley LA, Gabrielli WF, Kilgore E, Shah P. Sertraline response in adults with mental retardation and autistic disorder. J Clin Psychiatry. 1996 Aug;57(8):333-6. PubMed
18. Steingard RJ, Zimnitzky B, DeMaso DR, Bauman ML, Bucci JP. Sertraline treatment of transition-associated anxiety and agitation in children with autistic disorder. J Child Adolesc Psychopharmacol. 1997 Spring;7(1):9-15. PubMed
19. McElroy SL, Casuto LS, Nelson EB, Lake KA, Soutullo CA, Keck PE Jr, Hudson JI. Placebo-controlled trial of sertraline in the treatment of binge eating disorder. Am J Psychiatry. 2000 Jun;157(6):1004-6.Click here to read PubMed
20. Murat Basar M, Atan A, Yildiz M, Baykam M, Aydoganli L. Comparison of sertraline to fluoxetine with regard to their efficacy and side effects in the treatment of premature ejaculation. Arch Esp Urol. 1999 Nov;52(9):1008-11. PubMed
21. McMahon CG. Treatment of premature ejaculation with sertraline hydrochloride: a single-blind placebo controlled crossover study. J Urol. 1998 Jun;159(6):1935-8. PubMed
22. Behan PO, Hannifah H. 5-HT reuptake inhibitors in CFS. J Immunol Immunopharmacology. 1995;15:66–69.
23. Riedel WJ, Eikmans K, Heldens A, Schmitt JA. Specific serotonergic reuptake inhibition impairs vigilance performance acutely and after subchronic treatment. J Psychopharmacol. 2005 Jan;19(1):12-20. PubMed
24. Rush AJ, Trivedi MH, Wisniewski SR, Stewart JW, Nierenberg AA, Thase ME, Ritz L, Biggs MM, Warden D, Luther JF, Shores-Wilson K, Niederehe G, Fava M; STAR*D Study Team. Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. N Engl J Med. 2006 Mar 23;354(12):1231-42. PubMed

Interesting facts

After unsuccessful treatment with an SSRI, approximately 25% of patients have a remission of symptoms after switching to another antidepressant (SSRI, bupropion (Wellbutrin) or venlafaxine (Effexor)) 24.
One property of sertraline is that it appears to be also a minor inhibitor of dopamine reuptake.
Zoloft may be effective in the treatment of refractory neurocardiogenic syncope in children and adolescents.
A study has shown that Zoloft is an effective treatment for impulsive aggressive behavior in personality disordered patients.
Sertraline is the only SSRI with a significant effect on the reuptake of dopamine and this may explain why it is the only of these drugs that does not raise the serum levels of the hormone prolactin.