Sertraline is also called sertraline hydrochloride. Sertraline is a selective serotonin reuptake inhibitor (SSRI) first developed by Pfizer. It was first listed in the UK in 1990. At that time, it was approved as the only drug to prevent the recurrence of depression. It is no exaggeration to say that sertraline is one of the favorite “weapons” of psychiatrists. Before sertraline was available, antidepressants and anxiolytics were mainly tricyclic drugs such as amitriptyline and doxepin. If these drugs were taken, patients had serious side effects and were difficult to receive long-term drug treatment.
After the advent of serqulin, many psychiatrists found that their work suddenly became easier. With the help of sertraline, the patient’s depressive symptoms, irritability, fatigue symptoms and anxiety can be effectively alleviated or alleviated. Moreover, its side effects absolutely reassure doctors and have high safety. In the decades of listing, it has quickly become one of the first choice drugs for the treatment of depression and anxiety disorders. In addition, sertraline is the first drug approved for the treatment of affective disorders in children and adolescents (6-18 years old), which shows how safe it is. Sertraline is also used to treat obsessive-compulsive disorder. It is generally believed that after the curative effect is satisfactory, continuing to take sertraline can effectively prevent the recurrence of the initial symptoms of depression and obsessive-compulsive disorder.
Generally speaking, sertraline achieves the therapeutic effect by increasing the content of neurotransmitters in the synaptic gap in the patient’s nervous system (that is, the gap between nerves and nerves, a bit like the gap between joints). At present, medical research believes that the neurotransmitters affecting human emotional fluctuations mainly include serotonin, norepinephrine and dopamine. The content of these neurotransmitters in synapses decreases, which is the culprit leading to depression or anxiety.
The mechanism of sertraline hydrochloride is related to its inhibition of serotonin reuptake in central neurons. It ensures the effective concentration of synaptic space by inhibiting serotonin uptake by neurons, so as to achieve the clinical effect of treating depression and anxiety. But it has only a weak effect on norepinephrine and dopamine.
The average half-life of sertraline (the time required for the drug to metabolize in the body) is 22-36 hours, that is, if you don’t take sertraline for one day, its effective concentration in your body will drop by half. If you don’t take sertraline for two days, its drug concentration will drop to 1 / 4, and so on. Therefore, if you stop taking sertraline for more than three days, the concentration of sertraline will drop a lot, There is basically no therapeutic effect. Therefore, sertraline treatment emphasizes continuous administration on time every day to ensure effective therapeutic concentration. Generally, the human blood drug concentration will reach the maximum within 4.5-8.4 hours after continuous medication for 14 days, which is one of the reasons why sertraline takes effect slowly. Observe whether sertraline takes effect in the treatment of depression for at least 2 weeks.
Sertraline is metabolized mainly through the liver, and the main metabolite is n-demethylsertraline. Its pharmacological activity in vitro was significantly lower than that of sertraline. The final metabolites of sertraline and n-demethylsertraline were excreted in the same amount from feces and urine, and only a small amount (< 0.2%) of sertraline was excreted from urine in its original form. Some people with poor liver and kidney function need to disable or use sertraline with caution. Even if the liver and kidney function is normal, after taking sertraline for a period of time, they should also review the liver and kidney function to prevent abnormal liver and kidney function.
Common adverse reactions are
Adverse reactions in the instructions may occur, but they are definitely not 100%. As long as you take it according to the doctor’s advice, even if it happens, it is not fatal, so don’t reject it because of so many side effects. Both doctors and patients, especially prescribing doctors, should be very aware of the possible adverse reactions as long as they apply this drug.
Gastrointestinal tract (most common, disappear after drug adaptation): diarrhea / loose stool, dry mouth, dyspepsia and nausea. Abdominal pain, constipation, pancreatitis and vomiting.
Reproductive system and breast: sexual dysfunction (mainly male ejaculation delay), galactorrhea, male breast overdevelopment, irregular menstruation and abnormal erection of penis（ In fact, most patients with depression have decreased sexual desire, which may be mistaken for sexual dysfunction. Through sertraline’s treatment, some people’s sexual desire can be restored. As for sexual ability, everyone’s performance and expectations are different. There is no research on the impact of breast. Breast hyperplasia or summary in patients with depression is a common disease and needs comprehensive evaluation. Lactation and male breast overdevelopment are rare)
Blood and lymphatic system: neutropenia and platelet deficiency.
Heart: palpitation and tachycardia. Although it is rare, ECG needs to be checked before and after treatment to determine the effect of drugs on the heart.
Ear and labyrinth: tinnitus (relatively rare)
Endocrine: hyperprolactinemia, hypothyroidism and ADH secretion disorder syndrome（ (rare)
Ophthalmology: pupil enlargement and visual abnormalities（ The elderly are more common, but they will reduce after adaptation. Glaucoma patients should be cautious)
Hepatobiliary system: severe liver diseases (including hepatitis, jaundice and liver failure) and asymptomatic elevated serum aminotransferase (SGOT and SGPT).
Immune system: allergic reaction, allergy and anaphylactic reaction.
Metabolism and nutrition: increased appetite and hyponatremia, abnormal clinical test results, changes in platelet function, increased serum cholesterol, weight loss and weight gain.
Musculoskeletal and connective tissue: joint pain and muscle spasm.
Nervous system: coma, convulsions, headache, hypoesthesia, migraine, dyskinesia (including extrapyramidal side effects such as hyperactivity, increased muscle tension, molar and gait abnormalities), involuntary muscle contraction, paresthesia and fainting. There are also symptoms and signs related to serotonin syndrome, such as anxiety, confusion, sweating, diarrhea, fever, hypertension, myotonia and tachycardia caused by the simultaneous use of serotonin drugs（ Very rare)
Spirit: aggressive reaction, agitation, anxiety, depressive symptoms, euphoria, hallucinations, changes in sexual desire, nightmares and psychosis.
Kidney and urinary system: * urinary incontinence and urinary retention. More common)
Breathing, chest and mediastinum: bronchospasm and yawning.
Skin and subcutaneous tissue: alopecia, angioedema, facial edema, periocular edema, skin photosensitive reaction, pruritus, purpura, rash (including desquamate dermatitis, such as pleomorphic erythema: Stevens Johnson syndrome, epidermal necrosis and dissolution) and urticaria. hyperhidrosis.
Blood vessels: abnormal bleeding (such as epistaxis, gastrointestinal bleeding or hematuria), hot flashes and hypertension.
Trauma, poisoning and postoperative / surgical / operative complications: fracture (incidence – unknown (unable to judge from all current data)
Others: symptoms reported after sertraline withdrawal include anxiety, anxiety, dizziness, headache, nausea and paresthesia.
Food has no significant effect on the bioavailability of sertraline tablets, so there is no need to worry about whether to eat before or after meals（ Clinically, in order to reduce gastrointestinal reactions, it is often recommended that patients take it as soon as possible after meals.)