Sertraline is a selective inhibitor of central
serotonin reuptake. Thus, it enhances serotoninergic transmission--a property which appears to explain its
antidepressant activity. Its elimination half-life (approximately 26 hours) makes it suitable for once daily administration. Although clinical experience with
sertraline is limited, it appears to possess
antidepressant efficacy similar to that of
amitriptyline and
dothiepin, marginally better than
imipramine, and significantly better than placebo. Additionally,
sertraline is the only
antidepressant licensed in the UK for the prevention of recurrence of depression, and preliminary findings suggest that the
drug may also be effective in the treatment of
obsessive-compulsive disorder.
Sertraline and other
serotonin reuptake inhibitors possess tolerability advantages over
tricyclic antidepressants.
Sertraline has minimal
anticholinergic activity, is essentially devoid of cardiovascular effects, has a wide therapeutic index and may be administered to elderly patients or those with underlying cardiovascular disorders. However, as with other
serotonin reuptake inhibitors,
sertraline has been associated with gastrointestinal disturbances (
nausea, diarrhoea/loose stools) and male sexual dysfunction (primarily ejaculatory disturbance), although each of these effects is usually mild and transient, decreasing in frequency with continued treatment. As a
drug class,
serotonin reuptake inhibitors such as
sertraline appear to provide significant advantages compared with the more established
antidepressant agents, particularly in terms of tolerability. Although much broader clinical experience is required before
sertraline's full therapeutic potential can be realised, if future studies confirm the encouraging initial findings,
sertraline will undoubtedly become an important option in the treatment of depression.