sertraline, Zoloft
Intermittent versus continuous sertraline therapy in the treatment of premenstrual dysphoric disorders.

Alpay FB, Turhan NO.

Department of Psychiatry, Fatih University, School of Medicine, Ankara, Turkey.

OBJECTIVE: Premenstrual dysphoric disorder (PMDD) is a combination of mood disturbances and physical symptoms that reduce the quality of individual life and the functionality of the individual. Many women do not consider the complaints arising in the luteal phase of the menstrual cycle as a psychiatric disorder and, thus, do not seek treatment. Those who take their complaints to doctors usually apply to gynecology clinics. The aim of the present study is to analyze the psychiatric disorders observed in patients with PMDD and to compare the continuous and intermittent administration of sertraline. MATERIALS AND METHODS: PMDD was investigated in the patients admitted to the Gynecology Clinic of the Medical School of Fatih University. The patients were asked to fill out forms designed in accordance with PMDD diagnosis criteria as defined in DSM IV. RESULTS: Among the 267 patients who filled out the forms, 162 (60.7%) were PMDD positive. Of the PMDD-positive patients, 133 accepted a psychiatric interview; 36 (27%) of them had depression, obsessive-compulsive disorder, anxiety and somatoform disorders as an accompanying disorder. Out of 162 PMDD-positive patients 94 accepted medical treatment; 71 patients were given sertraline on a continuous basis, and 23 patients took sertraline intermittently in the luteal phase of the cycle. Because of side effects, 44 (62%) of the continuous therapy and 22 (96%) of the intermittent therapy group stopped medication. At the end of 6-month follow-up, continuous use of sertraline was found to be significantly more tolerated than intermittent therapy in the treatment of PMDD (chi2 = 7.88, p = 0.005). CONCLUSION: In patients with the symptoms of PMDD, psychiatric evaluation should be encouraged by gynecology clinics, and continuous administration of sertraline should be the choice because of patients' greater acceptance of the therapy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11563834&dopt=Abstract sertraline Zoloft



sertraline, Zoloft
Maternal sertraline treatment and serotonin transport in breast-feeding mother-infant pairs.

Epperson N, Czarkowski KA, Ward-O'Brien D, Weiss E, Gueorguieva R, Jatlow P, Anderson GM.

Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA. neill.epperson yale.edu

OBJECTIVE: Pharmacological treatment of postpartum depression is frequently complicated by the mother's desire to breast-feed. Although breast milk levels of several selective serotonin reuptake inhibitors (SSRIs) have been reported to be relatively low, a critical question is whether SSRI exposure during nursing results in clinically significant blockade of serotonin (5-HT) reuptake in infants. This study determined the degree of transporter blockade in infants exposed to sertraline through maternal breast milk. METHOD: The extent of maternal and infant transporter blockade was assessed by measurement of platelet levels of 5-HT in 14 breast-feeding mother-infant pairs before and after 6-16 weeks of maternal treatment with sertraline for major depression with postpartum onset. Plasma sertraline and desmethylsertraline levels were obtained in 13 of these mothers and 11 of their infants. RESULTS: Marked declines in platelet 5-HT levels of 70%-96% were observed in mothers after sertraline treatment, 25-200 mg/day. In contrast, infants showed little or no change in platelet 5-HT levels after exposure through breast-feeding. Mean levels of maternal plasma sertraline and its major metabolite, desmethylsertraline, were 30.7 ng/ml and 45.3 ng/ml, respectively. Drug and drug metabolite concentrations in the infants were at or below the lower limit of quantitation. CONCLUSIONS: The data indicate that while mothers receiving clinical doses of sertraline experience substantial blockade of the platelet 5-HT transporter, platelet 5-HT uptake in nursing infants of treated mothers is unaltered. The observations suggest that mothers taking sertraline can breast-feed without appreciably affecting peripheral or central 5-HT transport in their infants.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11578995&dopt=Abstract sertraline Zoloft



sertraline, Zoloft
High-performance liquid chromatographic method to screen and quantitate seven selective serotonin reuptake inhibitors in human serum.

Tournel G, Houdret N, Hedouin V, Deveau M, Gosset D, Lhermitte M.

Institut de Medecine Legale de Lille, Faculte de Medecine, Universite de Lille II, France.

A high-performance liquid chromatographic screening method (HPLC) is described for the determination of seven selective serotonin reuptake inhibitors (SSRIs) (fluvoxamine, milnacipran, paroxetine, sertraline, fluoxetine, citalopram, venlafaxine) and for three pharmacologically active N-demethylated metabolites (desmethylcitalopram, didesmethylcitalopram and norfluoxetine). A tricyclic antidepressant, clomipramine, was used as an internal standard. The method consists of liquid extraction of serum after alcalinisation at pH 9.50, followed by chromatography on a Beckman C18 reversed-phase column. Compounds were detected at 200.4 nm. The standard curves were linear over a working range of 50-1,000 ng/ml for fluvoxamine, 15-1,000 ng/ml for fluoxetine, 25-500 ng/ml for norfluoxetine, 50-500 ng/ml for sertraline, 20-500 ng/ml for paroxetine, 25-550 ng/ml for citalopram, 25-750 ng/ml for desmethylcitalopram, 25-800 ng/ml for didesmethylcitalopram, 25-650 ng/ml for milnacipran, and 25-500 ng/ml for venlafaxine. The quantitation limits of the method were 15 ng/ml for fluoxetine, 20 ng/ml for paroxetine, 25 ng/ml for venlafaxine, norfluoxetine and citalopram, and its metabolites, 40 ng/ml for sertraline and 50 ng/ml for fluvoxamine. No interferences were noted with this sensitive and specific method which can be used for therapeutic drug monitoring.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11587344&dopt=Abstract sertraline Zoloft



sertraline, Zoloft
Long-term costs of treatment for depression: impact of drug selection and guideline adherence.

Crown WH, Treglia M, Meneades L, White A.

MEDSTAT Group, Inc., Cambridge, MA, USA.

OBJECTIVES: This paper examines three processes: SSRI antidepressant choice, adherence to treatment guidelines, and long-term health care expenditures associated with antidepressant treatment for patients with a diagnosis of depression. METHODS: Patient records were abstracted from a medical claims database covering employer-provided health care plans. Treatment episodes required a 6-month antidepressant-free prior period; initial treatment with sertraline, paroxetine or fluoxetine; and data on direct medical costs over the 24 months following the initial prescription. The multivariate model of drug selection, patient adherence to antidepressant use guidelines, and cost was subjected to specification testing to rule out the possibility that nonrandom initial antidepressant selection might lead to sample selection bias. Further tests indicated that the results were free of bias due to a possible correlation between antidepressant selection and use of the medication, or because of the endogeneity of use patterns in the process driving cost. However, there was evidence of unobserved variables correlated with both achieving guideline adherent use and expenditures, which might have led to sample selection bias. RESULTS: Subjects who met the study criteria included 796 initiating therapy with sertraline, 352 with paroxetine, and 882 with fluoxetine. Fluoxetine patients were significantly more likely than sertraline or paroxetine patients to achieve a use pattern that was consistent with guidelines for treating depressive disorder (p < .05). There were no statistically significant differences between the three treatment cohorts in total direct health care expenditures over the 2-year period (p < .05), and depression-related expenditures, other mental health expenditures, and non-mental health care expenditures did not show significant differences across the treatments (p < .05). Natural logged values of antidepressant drug expenditures were predicted to be highest for fluoxetine, followed by sertraline, then paroxetine (p < .01). Predicted log values of mental health expenditures were lower for sertraline relative to fluoxetine. CONCLUSIONS: Fluoxetine patients had the highest likelihood of using antidepressant medication according to treatment guidelines that were developed to assure quality care. This benefit was achieved without incurring greater total health care expenditures.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11705297&dopt=Abstract sertraline Zoloft



sertraline, Zoloft
Plasma insulin levels are increased by sertraline in rats under oral glucose overload.

Gomez R, Huber J, Lhullier F, Barros HM.

Divisao de Farmacologia, Fundacao Faculdade Federal de Ciencias Medicas de Porto Alegre, Rua Sarmento Leite 245, 90050-170 Porto Alegre, RS, Brazil.

Recognition and control of depression symptoms are important to increase patient compliance with treatment and to improve the quality of life of diabetic patients. Clinical studies indicate that selective serotonin reuptake inhibitors (SSRI) are better antidepressants for diabetic patients than other drugs. However, preclinical trials have demonstrated that not all SSRI reduce plasma glucose levels. In fact, fluoxetine increases and sertraline decreases glycemia in diabetic and non-diabetic rats. In the present study we evaluated plasma insulin levels during fasting and after glucose overload after treatment with sertraline. Adult male Wistar rats were fasted and treated with saline or 30 mg/kg sertraline and submitted or not to glucose overload (N = 10). Blood was collected and plasma insulin was measured. The mean insulin levels were: fasting group: 25.9 +/- 3.86, sertraline + fasting group: 31.10 +/- 2.48, overload group: 34.1 +/- 3.40, and overload + sertraline group: 43.73 +/- 5.14 microU/ml. Insulinemia was significantly increased in the overload + sertraline group. There were no differences between the other groups. No difference in glucose/insulin ratios could be detected between groups. The overload + sertraline group was the only one in which a significant number of individuals exceeded the upper confidence limit of insulin levels. This study demonstrates that sertraline increases glucose-stimulated insulin secretion without any change in peripheral insulin sensitivity.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11717710&dopt=Abstract sertraline Zoloft



sertraline, Zoloft
Antifungal properties of selective serotonin reuptake inhibitors against Aspergillus species in vitro.

Lass-Florl C, Dierich MP, Fuchs D, Semenitz E, Jenewein I, Ledochowski M.

Department of Hygiene and Social Medicine, University of Innsbruck, Innsbruck, Austria. Cornelia.Lass-Floerl uibk.ac.at

This study investigated the fungicidal activity of selective serotonin reuptake inhibitors (SSRIs) against clinical isolates of Aspergillus fumigatus (n = 11), Aspergillus flavus (n = 9), Aspergillus terreus (n = 10) and Candida parapsilosis (ATCC 22019). The common drugs fluoxetine, seroxate, sertraline, paroxetine and reboxetine were applied in a broth microdilution test. In addition, we examined whether a post-antibiotic effect occurs following short exposure to the drugs. The various SSRIs showed time- and dose-dependent effects and were fungicidal towards the organisms tested. Sertraline and fluoxetine were the most active drugs, yet there were differences in the susceptibility of the various isolates tested. A lag of regrowth was dependent on the various SSRIs tested and their concentration. Treatment for 4 h at concentrations of sertraline below and equipotent to the minimal fungicidal concentration resulted in a lag of regrowth of 8-24 h for isolates of A. fumigatus and A. flavus. In conclusion, our in vitro studies clearly demonstrate antifungal effects of SSRIs. Animal studies are needed to evaluate the potential role of these psychotropic drugs in the management of fungal infections.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11733460&dopt=Abstract sertraline Zoloft



sertraline, Zoloft
Estrogen replacement therapy and antidepressant response to sertraline in older depressed women.

Schneider LS, Small GW, Clary CM.

Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA. lschneid hsc.usc.edu

The influence of the use of estrogen replacement therapy (ERT) on the antidepressant response to sertraline of 127 women over 60 years old was evaluated with data from two multicenter trials. At endpoint, sertraline-treated women taking ERT had significantly greater global improvement and quality of life than those not receiving ERT. Modest improvements were also observed in anxiety symptoms and cognitive functioning. The results provide preliminary evidence that ERT use (without progesterone) in older depressed women may augment the antidepressant response to sertraline in terms of quality of life and general improvement.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11739065&dopt=Abstract sertraline Zoloft