The drug sertraline belongs to the selective serotonin reuptake inhibitors (SSRIs). These are used primarily for the treatment of depression.
What is sertraline?
The drug sertraline belongs to the selective serotonin reuptake inhibitors (SSRIs). These are used primarily for the treatment of depression. The antidepressant sertraline, like the antidepressants citalopram and fluoxetine, belongs to the group of selective serotonin reuptake inhibitors. These influence the neurotransmitter balance and have a mood-lifting effect. For this reason, the active ingredient sertraline is used, among other things, for the treatment of anxiety disorders, obsessive-compulsive disorders and post-traumatic stress disorder (PTSD). Just like the other selective serotonin reuptake inhibitors, sertraline can develop various side effects. Particularly feared is serotonin syndrome, which can occur with concomitant use of various serotonergic medications or with sertraline overdose.
Pharmacologic effects
Sertraline exerts its effects in the synaptic cleft in the central nervous system. The synaptic cleft is located between a nerve cell and a downstream other (nerve) cell. Excitation is transmitted via the synaptic cleft. This requires messenger substances called neurotransmitters. Serotonin is one of these neurotransmitters. Among other things, the messenger substance acts in the central nervous system and is known for its mood-lifting effect. In common parlance, serotonin is therefore also known as the happiness hormone. Many depressions 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 does this by preventing the uptake of serotonin from the synaptic cleft into the surrounding cells. As a result, more serotonin remains in the cleft, so that the serotonergic effect is enhanced. Already during the first intake, the drug unfolds its drive-increasing effect. During the next one to three weeks, this effect intensifies and manifests itself.
Medical use and application
Sertraline is suitable for the treatment of major depression. In short-term use, the agent was clearly superior to placebo. This is not true for all selective serotonin reuptake inhibitors. Sertraline has also been shown to be helpful in the treatment of obsessive-compulsive disorder and panic disorder. In patients with social phobia, the active ingredient can also be used for therapy, but it takes around six weeks to 3 months for the first treatment successes to become apparent. Furthermore, the agent is widely used in the therapy of post-traumatic stress disorder. Here, too, however, delayed treatment success should be noted. Often, an improvement is only apparent after about three months. Here, the more severe the symptoms, the longer it takes for patients to respond to the drug.
Risks and side effects
Side effects are quite common when taking sertraline. More than 10 percent of patients treated with sertraline experience insomnia, fatigue, dizziness, and headache. Gastrointestinal disorders and dry mouth are also observed more frequently. As with most selective serotonin reuptake inhibitors, sexual dysfunction may occur with sertraline. For example, ejaculatory failure and inability to achieve orgasm are frequently observed in men. Usually, these sexual dysfunctions are reversible. However, there are patients in whom symptoms persist for several weeks or even months after discontinuation of the drug. Common side effects also include vomiting, profuse sweating, skin rash, and visual disturbances. Hot flashes, discomfort during urination, heart palpitations, and chest pain are also observed. Hallucinations, liver failure, coma, psychoses and Stevens-Johnson syndrome occur more frequently in connection with the use of sertraline, but a causal relationship has not yet been proven. Special caution is required in manic or hypomanic patients. In some test patients, manic symptoms increased while taking sertraline. Occasionally, however, exaggerated euphoria, depression, or hallucinations also occur. Studies also showed that suicidal behavior is forced in children and adolescents.The children and adolescents suffer from suicidal thoughts significantly more often than children and adolescents treated with other drugs. Increased hostility with increased aggression can also be observed. These side effects also occur in rare cases in adults. A rather rare but dangerous side effect is serotonin syndrome. This occurs mainly when sertraline is combined with other centrally acting drugs. These include drugs for depression (e.g., lithium or St. John’s wort), triptan-type migraine medications, and tryptophan. Serotonin syndrome is manifested by muscle tremors, high fever, clouding of consciousness, and muscle rigidity. Because MAO inhibitors potentiate the serotonergic effects of sertraline, they should not be co-administered with the selective serotonin reuptake inhibitor. Alcohol should also be avoided while taking sertraline. Similarly, the combination of sertraline with phenytoin and platelet aggregation inhibitors is not recommended. Furthermore, sertraline may also influence the effect of coumarins (vitamin K antagonists). Sertraline should not be stopped suddenly. If the drug is stopped too quickly and not phased out, patients may experience anxiety, dizziness, agitation, headache, tremor, nausea, and sweating. Although the symptoms subside within 14 days, it may take several months for all adverse drug effects to disappear. Women of childbearing age should only take sertraline if they are adequately protected against conception. The drug enters the fetal organism via the placenta and the umbilical cord. Although no harmful effects of the drug on the unborn child have been identified to date, damage cannot be ruled out. Nursing mothers should also avoid sertraline during the breastfeeding period.
