Sertraline is a
selective serotonin reuptake inhibitor (SSRI) with well established
antidepressant and
anxiolytic activity. Results from several well designed trials show that
sertraline (50 to 200 mg/day) is effective in the treatment of
major depressive disorder in elderly patients (> or =60 years of age). Primary endpoints in most studies included the Hamilton Depression Rating Scale (HDRS), Clinical Global Impression (CGI) score and the Montgomery-Asberg Depression Rating Scale (MADRS).
Sertraline was significantly more effective than placebo, and was as effective as
fluoxetine,
nortriptyline and
imipramine in elderly patients. During one trial,
amitriptyline was significantly more effective than
sertraline [mean reduction from baseline on one of six primary outcomes (HDRS)], although no quantitative data were provided. Subgroup analysis of data from a randomised, double-blind trial in elderly patients with
major depressive disorder suggests that vascular morbidity,
diabetes mellitus or
arthritis does not affect the
antidepressant effect of
sertraline. Secondary endpoints from these clinical trials suggest that
sertraline has significant benefits over
nortriptyline in terms of quality of life. In addition, significant differences favouring
sertraline in comparison with
nortriptyline and
fluoxetine have been recorded for a number of cognitive functioning parameters.
Sertraline is generally well tolerated in elderly patients with
major depressive disorder, and lacks the marked
anticholinergic effects that characterise the adverse event profiles of
tricyclic antidepressants (TCAs). The most frequently reported adverse events in patients aged > or =60 years with
major depressive disorder receiving
sertraline 50 to 150 mg/day were dry mouth,
headache, diarrhoea,
nausea,
insomnia,
somnolence,
constipation,
dizziness, sweating and taste abnormalities. The tolerability profile of
sertraline is generally similar in younger and elderly patients.
Sertraline has a low potential for drug interactions at the level of the
cytochrome P450 enzyme system. In addition, no dosage adjustments are warranted for elderly patients solely based on age.
CONCLUSION: