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Zoloft (sertraline) in psychiatry and general medical practice

Zoloft (sertraline hydrochloride) belongs to the class of selective serotonin reuptake inhibitors (SSRIs) and is well known to domestic psychiatrists as a highly effective antidepressant with a broad spectrum of activity. The basis of the psychotropic activity profile of the drug is a distinct thymoanaleptic effect with a weak stimulating component.

In recent years, a whole range of new data has appeared in the foreign specialized literature, shedding additional light on the indications for using zoloft in various types of mental pathology, as well as in a number of psychosomatic disorders.

Depressed

Chronic Depression

Zoloft is one of the main antidepressants used in depressive conditions that tend to chronify. To achieve the obvious effect in these cases, it is necessary 3-4 weeks, and sometimes more. Usually, the effect increases with the continuation of therapy. Nevertheless, in recent years, new data have appeared confirming the high efficacy of zoloft in the treatment of chronic depressions. A long study (76 weeks) was performed by a group of American scientists who studied by double-blind 77 patients who received Zoloft compared with the group (n = 66) that used placebo. After a 3-month treatment of the acute phase of depression, patients received drugs for a further 4-month period. The main objective of the study was the possibility of preventing a new episode of depression. Patients were studied in 12 US medical research centers. The results of the study confirmed the high efficacy of sertraline as a prophylactic agent for preventing exacerbation of depression. Depressive symptoms appeared during treatment with sertraline only in 20 (26%) of 77 patients versus 42 (50%) of 84 patients who received placebo. The authors conclude that sertraline is highly effective in the treatment of chronic depression.

In another multicenter study, imipramine and sertraline were compared with anxiety in the treatment of chronic depression. Eight US research centers participated. A total of 426 patients who received sertraline and 209 patients who received imipramine were studied. Clinical signs of anxiety were observed in 36% of patients. Treatment for 12 weeks demonstrated high efficacy of both drugs in similar conditions with a slight advantage of sertraline in the reduction of the anxious component of depression (60% compared to 58%). Treatment has significantly improved the patient’s quality of life and psychosocial status.

Seasonal Depression

Although officially seasonal depressions are not indications for prescribing zoloft, this possibility is discussed in recent years. Moscovich et al. (1995) compared the efficacy of sertraline / placebo (93/94 patients) for the treatment of this type of pathology for 8 weeks. Doses of sertraline ranged from 50 to 200 mg / day. The results of the study demonstrated the high effectiveness of sertraline in the treatment of seasonal depressions. The authors emphasize the insignificance of side effects, manifested in the form of rhinitis, diarrhea, insomnia and dry mouth. The researchers conclude that sertraline is effective and well tolerated in the treatment of this type of mental pathology.

Blashko et al. evaluated the effect of sertraline in the treatment of winter depression in a double-blind, placebo-controlled study lasting 8 weeks. Zoloft was used in 93 patients and placebo in 94 patients. The average daily dose was 111.3 mg. The drug showed a statistically significant advantage over placebo in all indicators of the scales used (HAM-D, HAM-A, CGI-I, etc.). There were no differences in cases of cessation of therapy due to side effects in both groups of patients. Nevertheless, it was found that in the group treated with zoloft, the average weight loss was 1.08 kg versus 0.06 kg in the placebo group. The authors concluded that sertraline is an effective and well-tolerated drug for the treatment of outpatients with seasonal affective disorders.

Atypical Depression

The use of zoloft in atypical depressions has been discussed very rarely, and such recommendations have never been officially reported. In the domestic literature, this was mentioned in 1995 by S.N. Mosolov. Individual studies on this topic include work by Beham et al., Who studied the effectiveness of sertraline and clomipramine in 40 patients who showed signs of atypical depression by DSM-III-R. The course of treatment lasted 8 weeks, the state was evaluated every 2 weeks, using the Montgomery-Asberg (MADRS) and CGI scales. The authors concluded that zoloft is at least as effective as clomipramine in the treatment of depressive symptoms in the structure of atypical depression. In recent years, interest in this problem has increased significantly. Mazo studied the effectiveness of SSRIs in an 8-week study of 45 patients who did not respond to treatment with amitriptyline. Most patients had atypical depression with obsessional and senesto-hypochondria symptoms. Daily doses of antidepressants were 50-100 mg sertraline, 20 mg fluoxetine, 100-200 mg fluvoxamine, respectively. About half of the patients (48.8%) were responders to SSRIs. The authors conclude that SSRI drugs were effective in cases where amitriptyline did not cause improvement.

Sogaard et al. compared the efficacy of sertraline and moclobemide in a 12-week double-blind study in patients with atypical depression. All patients met the DSM-III-R criteria for major depressions and had a score of more than 4 according to the Colombian criteria for ADDS (Atypical Depression Diagnostic Scale). The preparations were used in doses: sertraline - 50 mg / day (89 patients), moclobemide - 300 mg / day (83 patients). The doses in the course of therapy were increased to 100 mg / day (sertraline) and 450 mg / day (moclobemide).

As a result of treatment, HAM-D scores significantly decreased in patients taking both drugs, but the CGI scale (overall clinical improvement) showed a statistically significant improvement in the sertraline group since the 6th week of therapy (72.6% versus 57%; p = 0,012). This was most clearly manifested in the reduction of alarming symptoms, improved sleep. At the end of the study, only 13% of patients treated with zoloft met the criteria for atypical depression (25% in the moclobemide group). The quality of life of patients receiving sertraline, objectively improved. Although the frequency of side effects did not differ in both groups, the authors conclude that sertraline is more effective in treating atypical depressions.

Dystymia

In the last 2-3 years, a significant number of publications on the use of zoloft in the treatment of dysthymia have appeared. So, Ravindran et al. investigated this problem for 5 years in a randomized, multicenter study conducted in a double-blind with placebo control. Patients (n = 158) received sertraline or placebo (n = 152) for 12 weeks at doses of 50 mg / day (first time) and 200 mg / day (starting from the 2nd week). The results showed that patients who received zoloft were significantly faster and better out of depression according to the indications of all the scales and questionnaires used (HAM-A, HAM-D, MADRS, CGI, etc.). The most impressive were the improvements in quality of life. The authors conclude about the effectiveness of zoloft in the treatment of dysthymia, in cases where they are not accompanied by so-called major depressions. The same group of authors compared the effectiveness of sertraline and group cognitive behavioral therapy in the treatment of primary dysthymia. A total of 97 patients were studied who received treatment for a standard 12 weeks (placebo - 50 patients, sertraline - 47 patients). Of these groups, 25 patients treated with sertraline and 24 placebo in turn received cognitive therapy. The latter did not demonstrate apparent efficacy, although it slightly increased the results of effective treatment with sertraline. In general, it is shown that zoloft significantly improves the condition of patients with dysthymia, reduces clinical symptoms in comparison with placebo. Although behavioral therapy alone is not effective in these conditions, it does improve the results of treatment with sertraline. Browne et al. investigated the effectiveness of sertraline in a 2-phase, prospective, randomized study of 707 patients with dysthymic disorders (according to DSM-IV). During the first months, all patients received sertraline (50–200 mg / day) and individual psychotherapy (PI). In the second, 18-month phase, patients continued to be treated with sertraline or, if necessary, received another treatment. 586 patients completed only one phase. 525 patients completed the entire 2-year study. After 6 months, 59.7% of patients reacted positively to sertraline therapy, 57.5% responded to treatment with sertraline with PI (46.6% with one PI). At the end of the study, after 2 years, it was confirmed that treatment with zolofg (with or without PI) was more effective than isolated use of individual psychotherapy (p = 0.002).

Markowitz et al. in a randomized controlled 16-week study, 4 types of treatment were compared in patients with clean (without “major depression”) dysthymic disorders: PI, supportive psychotherapy, sertraline, PI + sertraline. Of the 93 patients, the study completed 71. Although there were no statistically significant differences between the groups, the authors showed that sertraline was more effective than other types of treatment in terms of the rapidity of symptom reduction.

Thase et al. in a multicenter, placebo-controlled study compared the effectiveness of sertraline and imipramine in 416 patients with dysthymia. Patients received up to 200 mg of sertraline, 300 mg of imipramine or placebo. 310 patients completed a 12-week study. Complete remission (according to the DSM-III-R criteria and the HAM-D scale) was obtained in 49.5% of patients treated with zoloft (43.5% in the imipramine group and 27.8% in the placebo). In the group of patients who received sertraline, the number of side effects was less, therefore 84% of patients completed the treatment (in the imipramine group, 67%). The authors conclude that good tolerability of zoloft is an important factor, since the chronic course of dysthymia dictates the need for long-term pharmacotherapy.

Kocsis et al. evaluated the psychosocial aspects of the previous study using a number of special scales and questionnaires (GAFS, SAS, LIFE, Q-LES-Q). The findings of the researchers coincided in the sense that sertraline was more effective in restoring the social functions of patients. Hellerstein et al., Analyzing the results obtained by Thase, joins conclusions about the high efficacy of sertraline in dysthymia. However, Lee, who studied the treatment of dysthymia in 48 patients for 6 weeks, did not find significant differences in the effectiveness of sertraline and amitriptyline.

Particular attention was paid to the age aspect of dysthymia sertraline treatment. So, Bellino et al. compared the efficacy of sertraline and amisulpride (50 mg / day) in elderly patients with dysthymia in an open, prospective, 6-month study. The researchers concluded that the effectiveness of both drugs and suggested to continue a more in-depth study of this issue using more tools. Nixon et al. studied the efficacy of zoloft in the long-term treatment of adolescent dysgia. In an open 6-month study of sertraline in doses of 50–200 mg / day, 23 adolescents aged 12 to 18 years received. He completed a 6-week course of treatment for 21 patients, a 16 -12 week course, and 9 patients underwent a full course of therapy. The greatest effect was manifested by the 6th week of therapy (p <0.05). Side effects (headache, runny nose) were insignificant. The authors conclude about the effectiveness of sertraline in adolescents suffering from dysthymia, especially in the acute period.

Thus, recent studies have confirmed the feasibility of using zoloft in the treatment of dysthymia.

Postpartum Depression

This testimony is also officially unregistered by the FDA, however, researchers willingly resort to ashlar in treating this type of mental pathology. So, Epperson et al. presented the results of a study of sertraline treatment of women who have experienced depression according to the DCM-IV criteria in the postpartum period. The study was placebo-controlled, performed by double-blind method for 6 weeks. Of the 13 women, 6 completed the full course; 4 out of 6 completed the study were rated by the responders, and 3 of them received sertraline.

The authors conclude that zoloft is effective in treating postpartum depression.

In an open prospective study of Stowe et al. studied the effect of sertraline in postpartum depression in 26 patients. HAM-D status assessments occurred every 2 weeks, the dose of zoloft was standard (50-200 mg / day). 21 women underwent the entire 8-week course of therapy, and in all cases there was an improvement in the condition from the 2nd week of treatment. In 14 patients after the course was complete remission was recorded. Sertralin was well tolerated, the side effects were mild and completely reduced by dose adjustment. Breastfeeding during treatment continued 6 women, which did not affect the children. The authors draw conclusions about the high efficacy and good tolerability of zoloft in postpartum depressions, stipulating that after an open study, more in-depth approaches are needed.

Other types of mental pathology

Obsessive Compulsive Disorders

The effectiveness of sertraline in the treatment of obsessive-compulsive disorders (OCD) is well known to psychiatrists. Nevertheless, research continues to deepen these problems and expand our understanding of the possibilities of the drug in the treatment of mental pathology of OCD.

Thus, the long-term efficacy of zolofta at OCV was evaluated under the conditions of an 80-week multicenter study consisting of 2 phases.

In the first phase (52 weeks), patients were selected as responders for treatment (227 patients). In the second phase (28 weeks), sertraline was compared with placebo in a double-blind study. Doses of sertraline ranged from 50 mg / day to 200 mg / day. Due to the insignificant response to therapy, 9% of patients who received sertrchlin and 24% of patients who received placebo discontinued participation in the study. Acute exacerbation of OCD was observed in 12% of cases of sertraline treatment and in 35% with placebo. According to several scales, including CGI, sertraline was significantly more effective than placebo and was generally well tolerated with prolonged use. The authors conclude that zoloft is an effective drug for long-term treatment of OCD, it prevents the occurrence of exacerbations and causes minor side effects.

Greist et al. patients with OCD were evaluated who responded to sertraline or placebo therapy for 12 weeks and subsequently for 40 weeks, but already in a double-blind study. A total of 118 patients were selected (96 received Zoloft, 22 - placebo). All patients who received sertraline (as opposed to placebo), noted an improvement in the condition. Of the 87 patients who completed 52 weeks of the study, 59 (51 - sertraline and 8 - placebo) continued treatment in an open study. Based on the results of a 3-phase, long-term study, it was concluded that sertraline is significantly more effective compared to placebo with long-term treatment of OCD The severity of side effects (less than 10% of cases), manifested mainly in the form of headaches, dizziness, insomnia, fatigue, dyspepsia, tremor, dry mouth, decreased libido was insignificant.

Panic disorders

Despite the slight sedative effect, zoloft has a positive effect on patients with anxiety and panic disorders. At the same time, the reduction of anxiety occurs faster than on therapy with Prozac and some other antidepressants. Rapaport et al. studied the effectiveness of sertraline in the treatment of panic disorders in an 80-week multicenter study. For 52 weeks, 398 patients received sertraline starting at 25 mg / day. Gradually, the dose was increased to 200 mg / day, depending on the tolerance and clinical response of patients. Responders in the 2nd phase of the study were divided into 2 groups (sertraline - 92 patients and placebo - 89 patients). Approximately 70% in the zoloft group and 50% in the placebo group completed the study. Sertralin statistically significantly exceeded placebo in treatment efficacy (p = 0.04) and in the prevention of the occurrence of new episodes of panic attack (p = 0.005). Zoloft was well tolerated, and this tolerance increased with the duration of treatment. Among the side effects in the sertraline group, headaches prevailed, in the placebo group, headaches, insomnia. Laboratory values in both groups were not significantly different. The authors concluded that sertraline is an effective and safe treatment for panic disorders.

Post Traumatic Stress Disorders

Londborg et al. studied the effectiveness of sertraline in the treatment of post-traumatic stress disorders (PTSD) in an open-center 24-week study. Sertralin was prescribed in doses starting at 25 mg / day, and the dose was increased to 200 mg / day, depending on tolerance and clinical response. We analyzed data from 128 patients who were treated with acute zoloft. Progressive improvement in the treatment process was noted with the help of two special scales used to assess the condition of patients with PTSD. In 92% of the big responders, the initial clinical response was confirmed, and 54% of nonresponders in the 1st phase became responders in the 2nd phase. Sertralin was well tolerated, only 8.6% of patients dropped out of the study due to side effects. In general, side effects manifested in the form of headaches, insomnia, dry mouth, dizziness. The authors believe that sertraline is a highly effective treatment for PTSD in both the acute and the chronic phase of the disease.

In another study, 96 patients with PTSD who responded positively to treatment with sertraline (50–200 mg / day) were subsequently divided into 2 groups (sertraline and placebo) for 24 weeks to observe possible exacerbations; Phase 2 of the study lasted up to 28 weeks. Patients who received sertraline showed a more stable condition compared with the placebo group. These differences were statistically significant for both women and men.

Rapaport et al. thus, the effect of long-term treatment with sertraline was evaluated in 359 patients with PTSD. The authors conclude that long-term treatment with zoloft leads to a distinct and stable improvement of the condition of persons suffering from PTSD.

Alcoholism and drug addiction

In the open 12-week study, Brady et al. evaluated the effectiveness of sertraline (at a dose of 110 mg / day) in the treatment of PTSD, complicated by alcoholism, in 9 patients. Zolofta has been proven to reduce alcohol intake (P≤0,0005) and increase the number of days free from alcohol (p≤0.001) after treatment with sertraline. George et al. presented the preliminary results of an open pilot phase of a lengthy two-phase study that assessed the effect of sertraline on alcohol consumption. For 6 months, patients who received zoloft at a dose of 2.75 mg / kg per day regularly assessed the frequency of alcohol use, the severity of manifestations of alcohol dependence, and the inclination to use alcohol. After the end of treatment, patients undergoing therapy, found a significant (P≤0,01) reduction in alcohol consumption, severity of alcoholic manifestations. It was noted that in 61% of cases, craving for drinking alcohol decreased, up to a complete abandonment of alcohol. The authors draw preliminary conclusions that treatment with sertraline seriously affects alcohol dependence. Eggerth et al. studied the effects of sertraline on the psychosocial problems of persons with alcoholism in the same group of patients. Used the DIC scale (Drinker Inventory of Consequences). After 6 months of treatment, indicators on this scale decreased by an average of 77.5 points. The greatest improvement was achieved in the first 2 months of therapy. The researchers conclude that treatment with zoloft not only leads to a reduction in alcohol consumption, but also contributes to significant positive shifts in the psychosocial sphere of patients.

Pettinati et al. Evaluated the effectiveness of sertraline (200 mg / day) in a 14-week, placebo-controlled, double-blind study of 100 patients with alcohol dependence (53 of them diagnosed with major depression according to DSM-III-R). Patients with a high risk of alcohol dependence (type B) and a low risk (type A) were studied. Compared with placebo, sertraline significantly reduced the number of days patients consumed alcohol for type A (0% versus 22.4%; p = 0.01), which was not observed in high-risk patients (type B - 82% versus 4.1%; p = 0.4b). The authors conclude that zoloft affects the reduction of alcohol consumption, sertraline is less effective in patients with a high risk of alcohol dependence.

Child psychiatry

Depressed

Donnely et al. evaluated the efficacy and safety of sertraline in the treatment of ambulatory patients aged 6 to 17 years with a diagnosis of "major depressive disorder". The authors presented the results of 2 identical, multicenter, placebo-controlled studies performed in a double-blind method for 10 weeks. 189 patients received sertraline (starting at 25 mg / day, maximum dose 200 mg / day), 187 - placebo. In the zoloft group, 143 patients completed the study (in the placebo group, 156 patients). The average dose of sertraline in those who completed the study was 131.1 mg / day. Children who received zoloft showed a significant decrease in symptoms on the CDRS-R (Children's Depression Rating Scale-Revised) scale compared with placebo starting from the 3rd week of treatment (p <0.05). Sertralin was well tolerated: only 8% of patients discontinued treatment due to side effects (2.1% in the placebo group). Among the side effects observed diarrhea, anorexia and agitation. The authors conclude that zoloft is effective in treating depressions in a children's clinic.

In a prospective open study by McConville et al. studied the effectiveness of sertraline in 13 adolescents (12-18 years old) who were treated in connection with a large depressive episode. Patients were observed in the hospital for 9-38 days with follow-up at home for up to 12 weeks. The dose of sertraline ranged from 25 to 200 mg / day, depending on the patient's clinical response. Common scales were used to assess the condition: HAM-D, MADRS, CGI-D, etc. The treatment with zoloft significantly reduced the indications for HAM-D (p = 0.027) and MADRS (p = 0.022). On other scales, improvement was also noted, but in terms of statistics, with minimal significant confidence. The side effects detected during the 12-week follow-up period included beatings represented by insomnia (69%), lethargy (61%), changes in body weight (46%), nightmares (39%), tension (31%), loss of appetite (31 %) and headache (31%). During the same period, side effects are significantly reduced in parallel with the disappearance of depressive symptoms. The authors conclude that sertraline can be successfully used in child psychiatry for treating “major” depressions, but it should be borne in mind that side effects are possible.

Ambrosini et al. conducted a prospective multicenter study on the use of sertraline in the treatment of major depressive disorders in adolescents (12-19 years old). After a 2-week evaluation period, patients received zoloft for 10 weeks. Responders continued treatment for another 12 weeks. The starting dose was 50 mg / day, maximum doses were reached by the end of the 3rd (100 mg), 6th (150 mg) and 9th (200 mg / day) weeks. In case of side effects, the dose was reduced. Assessment of the clinical condition was performed regularly using standard scales (M-SADS, HAM-DLI, GGI, etc.). 41 patients completed the 6-week treatment course, and 34 patients underwent a 10-week course of treatment with zoloft. Of the 47 patients, 26 (55.3%) patients showed a reduction in symptoms on the HAM-D scale by more than 50% by the end of the study. Improvement in all parameters was achieved by the 10th week (p = 0.0001). All evaluations showed a significant decrease in depression rates compared with the start of the study on all control days (p = 0.0001). Sertralin was well tolerated by adolescents, side effects were assessed as minor. The most frequently observed (but less than 10% of patients) headaches, insomnia and dizziness. The authors conclude that sertraline has proven to be an effective and well-tolerated anti-depressant for treating adolescents suffering from major depressive disorders.

Tierney et al. retrospectively, the therapeutic and side effects of sertraline were estimated at doses of 25–200 mg / day in 33 patients aged 8–18 years with a diagnosis of “major depressive disorder.” The patients' condition was assessed using CGI scales during 45 days of treatment. In 21 patients, receiving zoloft, the condition improved markedly (scores from 5.8 to 3.4 on the CGI scale), side effects were noted in 16 patients, while 8 patients discontinued therapy due to these manifestations. In 7 patients, behavioral changes were observed (2 patients developed hypomania.) The authors conclude that which matured children and adolescents may respond favorably to treatment Zoloft, but it should take into account the possibility of side effects.

Nixon et al. determined the effectiveness, safety and tolerability of sertraline with long-term treatment of major depressive disorders and dysthymia. A total of 21 outpatient patients aged 12 to 18 years were evaluated in an open 6-month study. 13 patients were diagnosed with a major depressive disorder, 8 - dysthymia. The HAM-D, HAM-A CGI scale was used. Sertralin was administered for 24 weeks in doses of 50 to 200 mg / day. 9 patients completed the full course of therapy. Both groups of patients showed significant clinical improvement (the best performance on the HAM-D scale is 76.9% of the positive response to therapy in depressed patients, 100% in patients with dysthymia). Side effects were insignificant and manifested only in the form of headaches. The authors conclude that zoloft may be effective in treating depression and dysthymia in children and adolescents.

OCD

At one time, zoloft received official FDA approval for the treatment of OCD in children aged 6 to 17 years. March et al. studied the effectiveness of sertraline in the treatment of OCD (in 187 children and adolescents) in a double-blind, placebo-controlled multicenter study. Dose sertalina 25-200 mg / day.

After the first phase of the study, patients were divided into two groups: those who received sertraline (n = 92) and placebo (n = 95). The full course of treatment was 52 weeks. Patients were assessed using the NINIH-OCS and CGI scales. The results showed a significant reduction in symptoms in the group treated with zoloft (p = 0.005), compared with the placebo group from the 3rd week of the study. In the group treated with sertraline, 13% of patients completed the study earlier due to side effects (insomnia, agitation, tremor). The authors confirmed that sertraline is an effective and safe treatment for OCD in children and adolescents.

In two open source studies, Yohnston and Zombroso et al. also showed the effectiveness of sertraline in the treatment of OCD. resistant to treatment with other drugs. Long-term studies undertaken by Cook et al. Were aimed at studying the efficacy and safety of sertraline in outpatient patients aged 6 to 12 years (72 patients) and from 13 to 18 years (65 patients). These patients completed the entire study conducted by March et al. The evaluation of the effectiveness of treatment at the 52nd week of the study showed a statistically significant improvement in all measured parameters (p <0.001). The authors concluded that zoloft in doses of 50–200 mg / day is an effective and safe means for the long-term treatment of OCD in patients aged 6–18 years. Wibus et al. studied possible cardiovascular adverse effects in the treatment of sertraline in patients with OCD (the same sample described above). Carefully carried out research has led to the conclusion that zoloft is not only effective, but also does not cause any side effects or complications of the cardiovascular system.

Dysmorphophobia

El-Khatib et al. reported a 17-year-old adolescent suffering from dysmorphophobia on the background of severe depression that developed psychogenically. The patient stopped attending school, lost interest in favorite activities, often cried. Every day for 2-3 hours he spent in front of the mirror, being dissatisfied with the shape of his nose. Within 3 months, the patient received sertraline in a dose of 50 to 200 mg / day. Improvement of the condition occurred soon after the start of therapy, complete remission was achieved after 4 months. Side effects were not observed.

Thus, recent studies have significantly expanded our understanding of the effective use of sertraline in child psychiatry.

Psychosomatics

Cardiovascular disorders

Many studies have shown a high proportion of cardiovascular disorders in patients with depression. More recently, patients with cardiovascular disorders were excluded from any studies of anti-depressant drugs. Recent years have shown that sertraline is safe and well tolerated by such patients. The most illustrative in this regard is the SADHART project (Glassman et al.) In which patients with severe depression in the acute period (≤30 days) with myocardial infarction or undergoing an attack of coronary disease were studied. The study was a multicenter, placebo-controlled, double-blind, and lasted 24 weeks. The average age of patients 57 years, doses of sertraline 50-200 mg / day. Received sertraline 186 patients, placebo - 183. Almost all patients received the usual set of cardiotropic drugs. The study showed that sertraline was statistically significantly more effective than placebo according to estimates of the HAM-D and CGI scales. At the same time, the side effects in both groups practically did not differ in the frequency and severity of manifestations. In patients treated with sertraline, only diarrhea was observed more often. The authors conclude about the efficacy and safety of sertraline for cardiac patients suffering from depression.

McFarlane et al. We performed a randomized, placebo-controlled study to study the effect of sertraline in 38 depressed patients after myocardial infarction. Patients received 50 mg of sertraline per day. The study completed 27 patients, and none of them did not observe any side effect. The authors confirmed the view that sertraline contributes to the restoration of heart function in depressed patients after a heart attack.

Krishnan et al. studied the effectiveness of zoloft in elderly patients with depression, as well as with or without cardiovascular pathology. 220 outpatients with hypertension, coronary heart disease and other cardiovascular disorders, as well as depressive elderly patients without severe cardiac pathology were studied. As in the previous study, all patients tolerated sertraline treatment well, the frequency and severity of side effects of the beats are insignificant in all the studied groups. It was noted that recurrent depressive episodes are more characteristic of patients with cardiovascular pathology (54> 3b%, p <0.01). Sertralin equally effectively influenced depression in both study groups. Thus, the efficacy and safety of zoloft was again demonstrated, and Rasmussen also confirmed it, who with the help of this drug tried to prevent the development of depression in stroke patients. 138 patients were studied for 12 months. Sertralin demonstrated a significant advantage over placebo in this component of the study, and also had a positive effect on improving the cognitive functions of patients. In the group treated with zoloft, lower blood pressure numbers were noted, tachycardia decreased (7% vs. 22%).

Pulmonary diseases

We found one work (Smoller et al.), In which an attempt was made to treat pulmonary diseases with sertraline (5 patients diagnosed with bronchial asthma and 2 patients with chronic obstructive pulmonary disease). Of the 7 patients, 4 did not suffer from depression or anxiety. All of them received the main treatment: steroids, bronchodilators, theophylline. After sertraline was added to the main therapy, 6 patients improved. This was manifested primarily in the reduction of shortness of breath. The authors suggested that the subjective sensations of improvement are associated with a possible relief from the symptoms of anxiety or due to a direct effect on the central nervous system. It is assumed further study of this issue.

The work of recent years has greatly enriched the clinical experience of psychiatrists in working with sertraline. Diverse actions of zoloft and safety of its use expand the possibilities of clinicians in the fight against various types of mental pathology. Sertralin has become actively and successfully used in different age groups, somatic pathology is not an obstacle in the treatment of mental disorders with zoloft. And finally, sertraline remains a highly effective treatment for various types of depression, and the steepness of these prescriptions is constantly expanding.