Fluoxetine ( Prozac ) and Sertraline HCL ( Zoloft )dosages in major depression.

In a retrospective study, we sought to determine medication dosages usually prescribed to obtain euthymia in 59 outpatients with a diagnosis of major depression treated with Fluoxetine ( Prozac ) or Sertraline HCL ( Zoloft ). Charts of veterans admitted to the outpatient mental health clinic at the West Los Angeles Veterans Hospital with a diagnosis of major depression and treated with either Fluoxetine ( Prozac ) or Sertraline HCL ( Zoloft )were reviewed. Progress notes were analyzed for a 6-month time period after the initiation of the medication treatment, and improvement was rated by a physician blind to the drug used for treatment. No significant differences were found in overall response rates between the Fluoxetine ( Prozac ) (81% responders) and Sertraline HCL ( Zoloft )(76% responders) groups. Eighty-one percent of the Fluoxetine ( Prozac ) responders compared to 32% of Sertraline HCL ( Zoloft )responders were at the manufacturer's recommended starting dose (MRSD) at the time of clinical response. One-third of patients receiving Sertraline HCL ( Zoloft )were started on or rapidly titrated to more than 50 mg/day. When only those patients receiving an adequate trial of Sertraline HCL ( Zoloft )at 50 mg were considered, 47% required a dose increase to achieve a remission. These data suggest that 50 mg of Sertraline HCL ( Zoloft )may be inadequate for some patients to achieve a resolution of symptoms of major depression and that many clinicians currently prescribe in a manner suggesting that they believe the MRSD is a suboptimal dosage.

Sertraline HCL ( Zoloft )and desmethylSertraline HCL ( Zoloft )in human breast milk and nursing infants.

OBJECTIVE: The purpose of this study was to determine the concentrations of Sertraline HCL ( Zoloft )and desmethylSertraline HCL ( Zoloft )in both human breast milk and infant serum. METHOD: Breast milk samples from 12 women were collected at specific time intervals after oral doses of Sertraline HCL ( Zoloft )(25-200 mg once daily). For 11 mother-infant pairs, maternal serum levels 24 hours after a dose and their infants' serum levels 2-4 hours after nursing were ascertained by high-performance liquid chromatography. RESULTS: Sertraline HCL ( Zoloft )and desmethylSertraline HCL ( Zoloft )were present in all breast milk samples, with a gradient from "fore" milk to "hind" milk. The highest concentrations of Sertraline HCL ( Zoloft )were observed in hind milk 7-10 hours after maternal dose. Increasing the maternal dose of Sertraline HCL ( Zoloft )resulted in increased breast milk concentrations of both Sertraline HCL ( Zoloft )and desmethylsertraline. Detectable concentrations of Sertraline HCL ( Zoloft )were found in three nursing infants and desmethylSertraline HCL ( Zoloft )in six. No adverse effects of exposure were observed in any infant. CONCLUSIONS: Sertraline HCL ( Zoloft )and desmethylSertraline HCL ( Zoloft )were present in the breast milk of nursing women treated with Sertraline HCL ( Zoloft ). Concentrations were affected by aliquot of milk sampled, time after maternal dose, and maternal daily dose. The infants' serum concentrations detected were below the detection limit of most commercial laboratories. The presence of desmethylSertraline HCL ( Zoloft )in six infants' samples underscores the importance of metabolite monitoring in determining infant exposure. Estimates of daily infant exposure can be determined after analysis of Sertraline HCL ( Zoloft )and desmethylSertraline HCL ( Zoloft )concentrations from one full breast at maternal serum steady state. Future studies of breast milk and infant serum samples should address these issues.

Effect of Sertraline HCL ( Zoloft )hydrochloride on cardiac autonomic dysfunction in patients with hemodialysis-induced hypotension.

BACKGROUND/AIMS: It was previously shown that Sertraline HCL ( Zoloft )hydrochloride treatment improved hemodynamic parameters of patients with dialysis induced hypotension (DIH). The aim of this study was to examine the effect of Sertraline HCL ( Zoloft )on the autonomic functions of patients with DIH. METHODS: Ten patients with DIH, 10 hemodialysis patients without DIH and 10 healthy control subjects were included into the study. All of the patients were treated with Sertraline HCL ( Zoloft )50 mg per day for 4 weeks. Pre-treatment and post-treatment heart rate variability (HRV) in supine and tilt position was evaluated. In order to evaluate the autonomic response to tilt position, gap values were calculated by subtracting the HRV in supine position from the HRV in tilt position. RESULTS: Analysis of the HRV response to tilt, demonstrated a paradoxical reduction in the indices of sympathetic modulation and sympathovagal balance in the patients with DIH while there was an increase in normalized powers of low frequency components (LFNU) and low frequency to high frequency components ratio (LFP/HFP) in the patients without DIH and control group. The number of therapeutic interventions for restoration of DIH decreased significantly in the Sertraline HCL ( Zoloft )period (p < 0.001). The gap values of the patients with DIH in LFNU (sympathetic modulation) (p < 0.05) and LFP/HFP (sympathovagal balance) increased in the Sertraline HCL ( Zoloft )period (p < 0.01). The decrease in gap value of normalized powers of high frequency components (parasympathetic modulation) was pronounced in the Sertraline HCL ( Zoloft )period in the patients with DIH (p < 0.05). CONCLUSION: The preventive effect of Sertraline HCL ( Zoloft )on DIH might be related to the improvement of regulation of autonomic response to hypovolemia.

Treatment outcomes in type A and B alcohol dependence 6 months after serotonergic pharmacotherapy.

BACKGROUND: Evidence supporting the use of serotonergic medications for the treatment of alcohol dependence is available from studies where pharmacotherapy targeted specific alcoholic subtypes. We previously established with Babor's alcohol typology that type A "lower risk/severity" alcoholics (n = 55) had better treatment response to 14 weeks of Sertraline HCL ( Zoloft )(200 mg/day) than placebo, and this was not found for type B "higher risk/severity" alcoholics (n = 45). The purpose of this study was to assess in this original study group whether treatment gains in the type A alcoholics were maintained or whether treatment outcomes changed for the type B alcoholics after discontinuing pharmacotherapy. METHODS: After the end of a 3-month course of 200 mg/day Sertraline HCL ( Zoloft ), the subjects were interviewed at several time points about their alcohol drinking, if any, using the timeline follow-back method. For 90% of the original study group, mixed effects and generalized estimating equation models were used to compare monthly drinking amounts over a 6-month posttreatment period with drinking amounts in the last month of treatment. RESULTS: We found that type A alcoholics who had been treated with Sertraline HCL ( Zoloft ), in contrast to placebo, maintained the good outcomes they had achieved during treatment for at least 6 months after pharmacotherapy. We found that type B alcoholics who had been treated with Sertraline HCL ( Zoloft ), in contrast to placebo, continued to show no advantage for pharmacotherapy in the 6 months after completing treatment. In addition, heavy drinking in type B alcoholics increased over the 6 months postpharmacotherapy in those initially treated with Sertraline HCL ( Zoloft )compared with placebo. CONCLUSIONS: These data support the importance of considering alcohol subtype when pharmacologically treating alcohol dependence.