Zoloft (Sertraline)

Zoloft. The possibilities of clinical application.

Currently, one of the most common painful conditions is depression. This is increasingly the case that the first doctor in charge of the patient with the symptoms of depression is not a psychiatrist, a local doctor - therapist, neurologist, cardiologist or other specialists clinics or hospitals. Very often patients with depression can be met at a reception at the neurologist.

One of the modern drugs that can be recommended for use in general practice is sertraline (INN: Sertraline), which belongs to a class of selective inhibitors of serotonin reuptake (SSRIs). This drug was developed by the company "Pfizer" and registered in the Russian Federation under the "Zoloft" trademark. Sertraline (Zoloft) has a high efficiency, comparable with the efficiency of the treatment of tricyclic antidepressants, but it differs significantly better tolerability and a higher safety profile [Casey D.E., 1994].

Mechanism of action

Sertraline inhibits the reuptake of serotonin (5-HT) neurons in the central nervous system and is superior in this respect amitriptyline 100-200 times, 9 times, fluvoxamine, fluoxetine, clomipramine and 5 times 2 times. As a result, it increases serotonin in the synapses, what linked the antidepressant effect of sertraline and antitrevozhny. Thus sertraline has very little effect on the reuptake of noradrenaline and dopamine. Sertraline does not inhibit monoamine oxidase. Selectivity sertraline serotonin and low affinity for adrenergic, cholinergic, GABA, dopamine, histamine, serotonin and benzodiazepine receptors causes a lower incidence of cardiovascular, anticholinergic and sedative side effects such as dry mouth, mist, weight gain, constipation, orthostatic hypotension and sedation that often arise in the treatment of tricyclic antidepressants.

Zoloft (Sertraline) Pharmacokinetics

Some of the positive properties of sertraline is associated with features of its pharmacokinetics. The latter are also key differences from other SSRI sertraline. When the 14-day application of the sertraline dose of 50-200 mg once daily maximum plasma concentration of the drug attained within 4,5-8,5 hours. plasma half-life period is 26 hours, which is sufficient to receive a single daily dose, thus eliminating the risk of drug accumulation and development of dose-related side effects (unlike fluoxetine, where half-life of 3.2 days). When taken regularly at doses of 50-200 mg once a day equilibrium state is reached within about 1 week. In equilibrium, the rate of absorption of sertraline is equal to its rate of excretion, so the levels of the drug remain practically constant.


The drug sertraline (Zoloft) was designed (intended) as the remedy for psychiatric practice. Therefore, the testimony given to the use of depression, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder (PTSD) and social phobia. There are a large number of studies have confirmed the effectiveness of sertraline (Zoloft) for these violations. However, the current use of the drug is out of the scope of psychiatry. This was largely due to the high prevalence of depression in general practice. Thus, approximately 60-80% of patients with depression do not come to the attention of psychiatrists and internists are treated by doctors, because among them is dominated by patients with mild forms of atypical depression. A large proportion of these patients is found in the practice of neurologists. Softer effect of sertraline (Zoloft) and a favorable safety profile make it possible to apply it more widely by physicians of different specialties. In addition, there is recent research has shown high efficacy of sertraline (Zoloft) and a variety of chronic pain syndromes [Gustaw K., 200; Engel C.C., 1998; Goodnick P.J., 1997; Singh N.N., Misra S., 2002].

Panic disorder treatment with sertraline (Zoloft)

Panic disorder is a chronic condition characterized by the repeated occurrence of sudden panic attacks. A panic attack is an episode of sudden fear or discomfort, in which suddenly appear palpitations or increased heart rate, sweating, tremor or chills, feeling of lack of air, choking, pain or discomfort in the chest, nausea or indigestion, dizziness, unsteadiness or fainting, derealization (feelings of unreality) or depersonalization (loss of one's own self), the feeling of losing control, fear of dying, paresthesias, chills or hot flashes.
Panic disorder is usually accompanied by distress and disadaptative in connection with the suspense of new attacks, concern about their effects and / or significant changes in behavior associated with panic attacks. These patients are characterized by high consumption of health care services and a pronounced decrease in the quality of life. They can often be found at the doctor in the clinic. They make numerous physical symptoms, such as chest pain, nausea, dizziness.
Panic disorder is often associated with depression, abuse of alcohol or other substances, as well as other anxiety disorders including social phobia, generalized anxiety disorder, OCD and PTSD. There are various medications and non-drug methods to successfully deal with the treatment of panic disorder. This SSRIs are the drugs of choice (first line) with the pharmacotherapy of panic disorder. Among SSRI sertraline (Zoloft), characterized in that it is effective not only in improving the symptoms of panic. Sertraline (Zoloft) reduces the anxious expectation of new attacks and significantly improves (various aspects of) the patient's quality of life. The study Pollack MH, Marzol PC (2000) have shown that sertraline (Zoloft) was effective even in patients with poor prognosis of disease outcome (agoraphobia, comorbid depression, personality disorder, high duration of the disease, female gender).
Panic disorder is a chronic disease, so the patient responding to treatment, therapy should be continued. Thus it is necessary to choose the lowest effective dose, and periodically evaluate the need to continue maintenance therapy.

The use of sertraline (Zoloft) in chronic pain

Antidepressants are very effective means of relief of chronic pain of various origins and have not only the analgesic effect, but also greatly reduce its accompanying emotional (affective) response, ie, make it easier to experience the pain and suffering of the patient.
After all, following the reduction of pain usually appears clear psychoactive effects: improves mood, increases efficiency, restores interests disappear phobic symptoms (pain suspense). Changing the perception of pain itself and the attitude to it - it becomes more rational, it eliminated its affective saturation.
There is a gradual distancing of the individual from the pain, which allows her to activate defense mechanisms and adaptive capabilities. Antinotseptivnye properties of antidepressants were found almost immediately after their introduction in psychiatric practice.
For 40-year history of the use of a huge number of open and well-controlled studies have been performed to prove their effectiveness in chronic, organic pain syndromes of different etiologies, including those resistant to the use of conventional analgesics.
Theoretically antinotseptivny antidepressants can exert effects on three main mechanisms: redutsiruya depression potentiating effect of exogenous or endogenous analgesic agents due to their own analgesic properties.
This fact is confirmed by the data obtained in experimental studies in animals and humans show that antidepressants increase the pain threshold and have antinotseptivny effect associated with direct exposure to the opiate receptors. However, it remains unclear whether the stimulation of opiate receptors occurs primarily or indirectly, via activation of noradrenergic and serotonergic neurons.
Modern theories of endogenous pain control require involvement of the two neurotransmitter systems (noradrenergic and serotonergic). Therefore mainly used tricyclic antidepressants for the treatment of chronic pain.
However, in some cases, a good effect can be achieved with the use of drugs that act mainly on the serotonergic system. Work was carried out, which showed high efficacy of sertraline (Zoloft) in the treatment of tension-type headache, with pain dysfunction syndrome temporomandibular joint, with musculo-fascial pain syndrome, pain in women with pelvic and even in diabetic polyneuropathy [Gustaw K. 2000; Engel C.C. Jr, 1998; Goodnick P.J., 1997].


Buy Zoloft (Sertraline) 100mg, 50mg or 25mg online

Zoloft is available in tablets of 25, 50 and 100 mg. The standard dose of the drug - 50 mg per day. Zoloft is prescribed once a day - in the morning or in the evening. Depending on individual sensitivity to the drug and other indications the dosage range in adults and adolescents can vary from 50 to 200 mg / day, children from 6 to 12 years -. 25 to 200 mg / day. In patients with impaired liver function should be to reduce the dose or multiplicity of the drug. Older people are recommended same dose as adults. However, given the often encountered greater sensitivity of older people to drugs in general, it is advisable to start treatment with lower doses than in younger people.

• disorders of the autonomic nervous system (ejaculation disorder, dry mouth, sweating);
• disorders of the central and peripheral nervous system (somnolence, tremor);
• general (fatigue);
• gastrointestinal disorders (anorexia, constipation, diarrhea, or an unstable chair, dyspepsia, nausea);
• psychiatric disorders (agitation, anxiety, insomnia, decreased libido).
In children, in addition, when using Zoloft may occur hyperkinesia, tick fever, malaise, purpura, weight loss, impaired concentration, manicheskie reaction, emotional lability, abnormal thinking and nosebleeds.

Do not wait for the rapid onset of effect of the drug. Symptoms of depression and a decreased interest in life usually disappear within 4-6 weeks after starting the drug. Reduction of certain physical symptoms and normalization of sleep may occur earlier, within 1-2 weeks after starting the drug, before they will be a tangible improvement in mood and will be of interest to any activity. This may be an indication that the therapy is effective. Nevertheless, after an appreciable improvement therapy should be continued. Before judge effectiveness against depression, Zoloft should take no less than 2 months. You can not on their own to stop taking or change the dose of the drug. Abrupt discontinuation of the drug may lead to one and / or more of the following withdrawal symptoms: irritability, nausea, dizziness, vomiting, nightmares, headache and paresthesia. Zoloft is usually taken to be 1 time per day. The tablet can be taken with food. At the beginning of the drug may have some side effects. The most common excessive sweating, drowsiness, nausea, diarrhea, tremors, dry mouth, loss of strength, headache, decrease or weight gain, dizziness and anxiety. These side effects are generally mild to moderate, and typically tested after 1-2 weeks with continued dosing. There may be a worsening of sexual function while taking Zoloft.

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