Sertraline is the second most important SSRI antidepressant (after fluoxetine) and one of the four most effective modern antidepressants (also venlafaxine, escitalopram and mirtazapine [1]).
Synonyms: Asentra, Zoloft, Stimuloton, Serenata, Sirlift, Deprefault.
It is believed that its effectiveness is comparable to amitriptyline itself and other tricyclics, but without their heap of terrible side effects; one and a half times more effective than fluoxetine. Like any other AD, SSRIs are suspected of exacerbating suicidal tendencies, but this has not been proven, unlike fluoxetine and again amitriptyline.
Created in 1991, in 2007 it was the most commonly prescribed antidepressant.
Shown
- Major depressive disorder; atypical depression with hypersomnia, increased appetite;
All indications except GAD are approved by the FDA.
Potential offline uses: patients with frailty (without depression), patients who want to avoid hyperprolactinemia (prepubertal adolescents, women with galactorrhea, unexplained amenorrhea, menopause without hormone replacement therapy) - sertraline does not increase prolactin, unlike other SSRIs.
Composition and release form of the medicinal product
The drug "Serenata" is produced in the form of film-coated tablets. The instructions fully describe the composition of the medication, which includes the active ingredient sertraline hydrochloride. The following additional elements were involved:
- microcrystalline cellulose;
- sodium carboxymethyl starch;
- anhydrous calcium hydrogen phosphate;
- hyprolose;
- magnesium stearate;
- polysorbate.
The tablet shell consists of hypromellose, titanium dioxide and propylene glycol. The medicine is produced in tablets of 50 mg and 100 mg. They are biconvex capsule-shaped. They are white and have a line on one side. Packed in 10 tablets in an aluminum blister. A cardboard pack may contain from 3 to 5 blisters plus instructions for use.
How does it work
- Increases the concentration of serotonin (a brain neurotransmitter).
- Blocks the uptake of serotonin by its transporter.
- Reduces the sensitivity of serotonin receptors, especially 1A.
- Presumably increases serotonergic transmission of nerve impulses.
- To some extent, it blocks the reuptake of dopamine, which enhances dopamine transmission and causes some therapeutic effects.
- It is a moderate antagonist of sigma receptors, which explains the anti-anxiety effect.
How long does it take to work?
Some patients may experience increased energy and activity at the very beginning of treatment.
- Most often, the effect is not observed immediately, but after 2-4 weeks.
- If there is no effect after 6-8 weeks, you should change the dosage or change the drug.
- Can be used for many years to prevent relapses.
If it works
- The goal of treatment is complete remission of current symptoms and prevention of relapses.
- Treatment most often reduces or eliminates symptoms, but is not necessarily curative, and symptoms may return after stopping use.
- Treatment continues until all symptoms are eliminated (remission), or until they are significantly reduced (for example, in the case of OCD or PTSD).
- For the first episode of depression, treatment must be continued for 1 year from the date of symptom relief.
- For the second and subsequent episodes of depression, the treatment period may be unlimited (continuous use).
- The duration of use for anxiety disorders can also be unlimited.
If it doesn't work
- Many patients respond only partially to therapy, with some symptoms improving but others remaining (especially insomnia, fatigue, and difficulty concentrating in depression).
- Some patients may not respond to treatment at all, i.e. they are resistant to sertraline.
- Others may initially have a reaction to the drug and then relapse even with continued treatment.
- It is necessary to increase the dosage, change the drug, or use an enhancing agent.
- Consider using psychotherapy.
- Re-exclude the possibility of another diagnosis.
- Some patients may show an apparent lack of permanent benefit due to activation of a latent or underlying bipolar disorder, in which case discontinuation of sertraline and initiation of mood stabilizers is required.
Poor response to therapy in the elderly may be associated with Alzheimer's disease.
Good combinations
- Trazodone, especially for insomnia. Other hypnotics.
It is worth remembering that using one antidepressant is preferable to combinations, so you must first go through the drugs and only then try to combine them.
Inhibits CYP450 3A4, increasing the concentration of beta blockers, atomoxetine, alprazolam, buspirone, triazolam, statins, pimozide and thioridazine. Not compatible with tricyclics and MAOIs (may cause fatal serotonin syndrome): you must wait 2 weeks after stopping sertraline.
Special instructions for the use of the drug Sertraline
During treatment with antidepressant or antiobsessive drugs, cases of exacerbation of mania or hypomania, and convulsions are possible. If convulsions occur in all cases, sertraline must be discontinued. Patients with depression are prone to suicide attempts, therefore, at the beginning of treatment, such patients should be under strict medical supervision. The effectiveness and safety of sertraline in children under 6 years of age have not been established. Sertraline should be used during pregnancy only when the expected benefit to the mother outweighs the possible risk to the fetus. Women of reproductive age must use adequate contraception during treatment with sertraline. There is no information on the penetration of sertraline into breast milk, so it is not recommended to prescribe it during breastfeeding.
Side effects
Seriously, it’s written in the manual about waiting three times.
It is believed that side effects develop due to an increase in the concentration of serotonin not only in the brain, but also in other organs. An increase in serotonin may cause an associated decrease in dopamine, but due to the partial blockade of dopamine reuptake by sertraline, this effect can be neutralized. Most side effects occur at the very beginning of use and go away over time, in contrast to therapeutic effects, which do not occur immediately and gradually increase.
- Gastrointestinal tract: loss of appetite, dry mouth, nausea, constipation.
- CNS: agitation, tremor, headaches, dizziness, sometimes sedation/insomnia.
- Sexual dysfunctions: M - delayed ejaculation, erectile dysfunction; F - decreased libido, anorgasmia.
What to do with side effects
- Wait.
- Wait.
- Wait.
- If sertraline causes activation, which leads to sleep disturbances, then it must be taken in the morning.
- Reduce dosage to 25 mg until side effects subside, then increase back to a tolerable dose, usually at least 50 mg per day.
- After a few weeks, change to another drug or add another one.
Sexual dysfunction can be treated with bupropion, sildenafil, vardenafil or tadalafil, or by switching to bupropion or mirtazapine.
Reviews from people who took the drug Serenata
“I was prescribed Serenata tablets by a doctor who helped me fight my fear of crowds. I was hesitant to take the medicine for a long time because of the bad reviews I read online. However, my fear of crowds, unfortunately, cannot be treated with herbs or herbal preparations.
My anxiety prevented me from going to the capital on business trips. Even a trip to the local shopping center could result in a panic attack. After being unable to go to the grocery store due to fear, I decided to start treatment.
After 2-3 months I really felt better, but not 100%. Neuroses and inexplicable feelings of anxiety are gone. Now I can travel, go to parties. Over the past 6 months, I have only had 1 panic attack, but no thoughts of suicide (which I was so afraid of) arose. I am still taking Serenata, but my therapist is already preparing a withdrawal plan for this medication. Overall, I can recommend the drug."
Kudrin Alexey Egorovich, 28 years old
“I started taking Serenata after consulting with my doctor. The recommended dose of 50 mg (1 tablet) initially caused terrible side effects: headaches, nausea, dizziness. After a week of regular use, the side effects weakened, and after a month they disappeared altogether. However, after 3 months of therapy, my husband began to say that the drug was negatively affecting me. I didn’t realize this because I thought that the absence of a negative reaction to any events was the norm.
But when I began to analyze the past time, I realized that I did not react to the positive news in any way. Even when my child announced victory at the city Olympics, I was not happy. And in general, there was a feeling of inner emptiness, as if I had become a person without emotions. My husband persuaded me to stop drinking Serenade. For a month I tried to take half a tablet, and then a quarter.
Side effects appeared, but not as strong as in the first month of taking the drug. Now, of course, I have depressive moods again, but I regularly exercise, walk in the fresh air and try to watch my diet. I can say that the reviews about the antidepressant Serenata are true, the drug works. And everyone must decide for themselves whether the result is worth such side effects.”
Norkina Irina Vitalievna, 35 years old
“I work as a pharmacist in a pharmacy, so I admit honestly: when I showed signs of depression, I did not go to the doctor, but decided to find the medicine myself. Of course, this is wrong, but customer reviews about the antidepressant Serenata were quite good. I took 50 mg/day for three months. Unfortunately, my depressed mood did not disappear, but nightmares and a certain fog of consciousness appeared.
Although, frankly speaking, in the first week of treatment I experienced an extraordinary influx of physical energy, but psychologically I felt even more depressed than before starting treatment. To improve my mood, I started cycling to work and drinking herbal teas. But nothing has changed.
Another three weeks of regular use of Serenata led to a constant feeling of fatigue, the appearance of causeless anxiety, and general anxiety. By the end of the three-month course of treatment, I completely lost my appetite and even lost weight. The side effects in my case were so intense that all possible benefits of Serenata were minimized.”
Zinovieva Olga Denisovna, 29 years old
How
From 50 to 200+ mg per day; 50 mg is the minimum effective dosage, most patients require an increase.
- Depression and OCD: 50 mg for the first few weeks to assess the effect, then increase once a week as needed to 200 mg per day in one dose. Some patients with OCD respond to therapy only at a dose of 400 mg, which is considered safe but should be used by experts.
- Panic attacks and PTSD: first 25 mg per day, from the second week 50 mg, after a few weeks evaluate the effect, if necessary, increase once a week to 200 mg per day in one dose.
The more agitated and anxious the patient, the lower the starting dose should be, the slower the increase and the more advisable it is to add an anxiolytic; patients with previously identified poor tolerance to antidepressants should begin treatment with 12.5 mg per day.
Long-term use is considered safe.
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Gradual decrease:
- most patients tolerate a 50% dosage reduction for three days, then another 50% for three days, then complete withdrawal;
- if withdrawal symptoms occur (dizziness, nausea, paresthesia, sweating, abdominal cramps), then you need to increase the dosage back and, after the symptoms have subsided, begin a more gradual reduction.
Overdose of the drug Sertraline, symptoms and treatment
Possible death if the dose of sertraline is exceeded in combination with other drugs and/or alcohol. There is no specific antidote for sertraline. It is advisable to rinse the stomach, prescribe enterosorbents, monitor vital functions, ensure airway patency and adequate ventilation, and provide symptomatic and supportive therapy. Given the large volume of distribution of sertraline, forced diuresis, dialysis, hemoperfusion and exchange transfusion are ineffective.
List of pharmacies where you can buy Sertraline:
- Moscow
- Saint Petersburg
