Adis International Limited,
Auckland, New Zealand.
sertraline is a selective serotonin
reuptake inhibitor (SSRI) with well established antidepressant
and anxiolytic activity. Results from several well
designed trials show that sertraline (50-200 mg/day)
is effective in the treatment of major depressive
disorder in elderly patients (>/=60 years of age).
Primary endpoints in most studies included the Hamilton
Depression Rating Scale (HDRS), Clinical Global Impression
score and the Montgomery-Asberg Depression Rating
Scale. 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 >/=60
years with major depressive disorder receiving sertraline
50-150 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: sertraline is an effective and well
tolerated antidepressant for the treatment of major
depressive disorder in patients aged >/=60 years.
Since elderly patients are particularly prone to the
anticholinergic effects of TCAs as a class, SSRIs
such as sertraline are likely to be a better choice
for the treatment of major depressive disorder in
this age group. In addition, sertraline may have advantages
over the SSRIs paroxetine, Fluoxetine and fluvoxamine
in elderly patients because of the drug's comparatively
low potential for drug interactions, which is of importance
in patient groups such as the elderly who are likely
to receive more than one drug regimen.
