Sunday, March 15, 2009

Generic Zoloft.

Currently, one of the most common painful conditions is depression. In doing so, increasingly there is a situation where the first doctor in charge patients with symptoms of depression is not a psychiatrist, and the precinct a doctor - a physician, neurologist, cardiologist or other specialists, clinics or hospitals.

Especially in patients with depression can be found on the admission of the neurologist. In neurological patients of depression most often associated with Parkinson's disease, multiple sclerosis, intracranial tumors, especially in the temporal lobe, atherosclerosis of brain vessels.

More than two-thirds of patients with depression revealed the pain of varying intensity [Bair MJ, 2004], and severe pain associated with a higher degree of depressive symptoms [Katon W., 1994].

This has meant that the tools used not only to psychiatrists but also to neurologists, cardiologists, physicians, surgeons, dermatology and others, have also include antidepressant drugs. However, the lack of awareness about modern antidepressant leads to the predominant use of general practitioners, only long types of drugs amitriptyline, melipramina etc.

These drugs are powerful antidepressants, so far widely used in the psychiatric clinic, while deployed, a deep depression. In the same out-patient conditions, which mainly refers to the atypical, erased versions of depression occurring against the backdrop of somato-autonomic disorders, these drugs are relatively side effect, may have negative consequences.

In addition, traditional antidepressants (amitriptyline, etc.) because of poor tolerance of side effects may compromise the meaning of the treatment of depressive disorders in patients obschemeditsinskoy practice. Given what is particularly important to inform general practitioners about antidepressants, have a milder effect and without any marked side effects.

One of the modern drugs that can be recommended for use in obschemeditsinskoy practice is sertralin (INN: Sertraline), which belongs to the class of selective serotonin inhibitors reverse capture (SIOZS).

This product was originally developed by «Pfizer» and is registered in Russia under the brand name «Zoloft». Sertralin Generic Zoloft has a high efficiency, comparable to the effectiveness of the treatment of tricyclic antidepressants, but there has been much better portability and a high profile security [Casey DE, 1994].
Mechanism of Action

Sertralin inhibits reverse the seizure of serotonin (5-HT) neurons in the central nervous system, and superior in this respect amitriptyline in 100-200 times fluvoksamin 9 times, fluoxetin 5 times and 2 times clomipramine [Koe BK, 1990]. As a result of increased content of serotonin in the synapses, which link the antidepressive effect and antitrevozhny Setralin.

This sertralin has very little effect on the reverse capture norepinephrine and dofamina. Sertralin not inhibited monoaminooksidazu. Selectivity Setralin against serotonin and low affinity for adrenergic, cholinergic, GABA, DOPAMINE, gistaminovym, serotoninovym and benzodiazepinovym receptors leads to a lower frequency of cardiovascular, antiholinergicheskih and sedative side effects such as xerostomia, mist, an increase in body weight, constipation, orthostatic hypotension and sedation, often resulting in the treatment of tricyclic antidepressants.

Some positive sertralin properties associated with the peculiarities of its pharmacokinetics. The latter are also key differences from other Setralin SIOZS. When the 14-day application Setralin at a dose of 50-200 mg once daily maximum concentration of drug in plasma are achieved within 4,5-8,5 hours.

The half of the plasma is 26 hours, which is sufficient to receive a single daily dose, but eliminates the risk of cumulative drug dose and side effects (unlike fluoxetin, where the half life of 2-3 days). Regular admission at the doses of 50-200 mg once a day equilibrium state is achieved within approximately 1 week. In equilibrium condition the rate of absorption Setralin equal to the speed of its ascent, so the levels of the drug remained virtually constant.

Sertralin subjected to metabolism in the first passage through the liver. After the cessation of therapy sertralin 95% out of the body (otmyvochny period) for 1 week.
Comparative studies SIOZS and other antidepressants.

There are a large number of meta-analysis of antidepressants compared. According to these studies, SIOZS generally do not concede on the effectiveness of tricyclic antidepressants. This portability SIOZS much better than the portability of the tricyclic antidepressants . Profile of side effects also varies among SIOZS. Application SIOZS accompanied by significantly fewer antimuskarinovyh effects, with the increasingly common gastrointestinal effects and psihostimuliruyuschie.

Indications for use Generic Zoloft

The drug sertralin Generic Zoloft was developed (designed) as a drug for a psychiatric practice. Therefore, in testimony to the applicability of the depression, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder (PTSD) and social phobia.

There are a large number of studies have confirmed the effectiveness of Setralin Generic Zoloft when those violations. Currently, however, the use of drugs had gone beyond psychiatry.

This was largely due to the high prevalence of depression in obschemeditsinskoy practice. Thus, approximately 60-80% of patients with depression do not fall within the field of mental health treatment and medical internist, because they predominate among patients with mild forms of atypical depression.

A large proportion of these patients is found in the practice of neurologists. Milder effects Setralin Generic Zoloft and a favorable safety profile make it possible to apply it more widely by doctors of various specialties. In addition, recent studies have demonstrated high efficiency of application Setralin Generic Zoloft and with various chronic pain syndromes
Application Setralin Generic Zoloft with depression and anxiety
There is a lot of experience applying Setralin Generic Zoloft with a broad spectrum of depressive violations as endogenous and exogenous nature. Sertralin Generic Zoloft, can be used to treat high depressive disorder. Its effectiveness in the episode of major depression was established in 6-8-week controlled study in outpatients [Khouzam HR et al. 2003].
A separate mention should be made of the effectiveness of Setralin Generic Zoloft in the treatment of masked depression, which manifests itself in different neurological and somatic symptoms (including chronic pain syndromes).

These patients are usually reluctant to accept and carry bad tricyclic antidepressants. Monthly treatment sertralinom Generic Zoloft successfully resolves itself as a manifestation of depression, and worrying, and somato-vegetative symptoms, contributing to the normalization of sleep and the elimination of pain syndrome, regardless of the clinical picture of the prevalence of those or other somatic manifestations.

Recently, we investigate the effectiveness of sertralin Generic Zoloft in the depressions in the organic neurological disease. In neurological practice, very often, and with unfavorable prognostic point of view is the development of depression in patients suffering from Parkinson's disease.

Effectiveness sertralin Generic Zoloft in this situation is not inferior to amitriptyline. This application sertralin Generic Zoloft, but not amitriptyline significantly improves the quality of life of these patients.

Recent research has proved highly effective Setralin Generic Zoloft in the treatment of depression in Alzheimer's disease in combination with high portability, which allows to speak of sertraline Generic Zoloft as the drug of choice in this situation.

There is work that showed the high efficiency sertralin Generic Zoloft with postnatal depression and postmenopauzalnyh. Epperson et al. (1997) presented the results of 6-week placebo-controlled double-blind study the effectiveness of Setralin Generic Zoloft with this pathology. Of the 13 women received a full course of 6, 4 out of 6 completed the study were evaluated responderami, 3 of them were sertralin Generic Zoloft.

The authors come to conclusion on the effectiveness of Setralin Generic Zoloft in the treatment of postnatal depression. Stowe et al. [1997] investigated the influence of Setralin Generic Zoloft with depression in 26 patients. Was the standard dose (50-200 mg / day).. The entire 8-week course of therapy was 21 women, all marked improvement from 2 nd week of treatment. In 14 patients after the course has been recorded complete remission. Sertralin Generic Zoloft is well tolerated, side effects were minor and completely reduced by correcting the dose. Breast-feeding during treatment continued to 6 women that did not impact on children. However, it is unknown which may have influenced breast-feeding mothers taking drugs, for newborn babies in the long run. Therefore, the decision to use antidepressants for postpartum depression at kupirovaniya nursing mothers must be very balanced.

About 75% of women experiencing unpleasant feelings during the menstrual period in the form of headaches, worsening of mood according to epidemiological studies. In doing so, only in 3-8% of women, these and several other violations very seriously and expressed dezadaptiruyut women. In DSM-IV classification was introduced a special term for this condition - «perimenstrualnoe disforicheskoe disorder». Etiology of the violations are not clear. It is assumed that the physiological fluctuations in hormones rather than a violation of the ratio of the hormones are provocateurs of clinical manifestations perimenstrualnogo disforicheskogo disorder. Serotoninergicheskaya system is in close reciprocal relationship with sex hormones and is the most reasonable target for intervention. Of the drugs for this category of patients were the most effective drugs SIOZS group. In several randomized, placebo-controlled studies have shown drugs SIOZS high efficiency and minimal side effects. Recently, another study showed that even an effective periodic (only during perimenstrualnogo period) receiving the drug serotoninergicheskogo.

Application Setralin Generic Zoloft with obsessive-compulsive
disorder (ROC)

Sertralin Generic Zoloft is used to treat obsessy and kompulsy patients with ROC. ROC is characterized by intrusive ideas, thoughts, beliefs or the way (obsessiyami), which are distonicheskimi and / or repetitive, purposeful and intentional action (kompulsiyami) that a person sees as excessive or unreasonable. Effectiveness Setralin Generic Zoloft was set at 12-week and 52-week studies in outpatients diagnosed with ROC [Koran LM, 2002], and currently use Zolofta with ROC recommended American Psychiatric Association (2007).
Application Setralin Generic Zoloft in children and adolescents

Application Setralin Generic Zoloft are allowed to have children (6-12 years) and adolescents (13-17 years) only if ROC. Alderman J. et al. (2006) demonstrated the efficacy and safety of long-term therapy, even sertralinom Generic Zoloft in children with the ROC.

However, children treated with antidepressants should be undertaken with caution, given the increased risk of suicidal attempts in children and adolescents taking antidepressants [Cheung A., 2007]. Therefore, in the appointment of any antidepressant to children or adolescents should carefully weigh the risk ratio and the clinical feasibility of (harm and benefit), as well as closely monitor the mood and behavior of patients who have decided to appoint a drug.
Treatment sertralinom Generic Zoloft, panic disorder Panic disorder (PR) is a chronic condition, which is characterized by sudden re-emergence of panic attacks.

Panic attacks is a dramatic episode of fear or discomfort, which suddenly appear palpitations or increased heart rate, sweating, tremors or chills, feeling the shortage of air, asthma, pain or discomfort in the chest, nausea or indigestion, dizziness, fainting, or volatility, derealizatsiya (feeling not practical) and Depersonalization (loss of my own), a sense of loss of control, fear of death, paresthesia, chills or hot flushes.

Panic disorder is usually accompanied by distress and dizadaptatsiey due to disturbing the expectation of new attacks, concern about their effects and / or significant changes in behavior associated with panic attacks. These patients have high consumption of health services and pronounced decline in the quality of life. They are often found in the doctor in the clinic. They make numerous somatic complaints, such as chest pain, nausea, dizziness.

PR is often combined with depression, alcohol or other substances, as well as other disturbing irregularities, including the social fobiyu, generalized anxiety disorder, PTSD and the ROC. There are different medicinal and nelekarstvennye methods to successfully cope with the treatment of panic disorder. This SIOZS are drugs of choice (first line), with pharmacotherapy OL. Among SIOZS sertralin Generic Zoloft is different in that it is effective not only for improving the symptoms of panic.

Sertralin Generic Zoloft reduces the expectation of an alarming new attacks, and significantly improves (various aspects), the quality of life for the patient. In the study, Pollack MH, Marzol PC (2000) showed that sertralin Generic Zoloft was effective even in patients with poor prognosis of disease outcome (agoraphobia, komorbidnaya depression, personality disorder, high duration of disease, female sex).

Panic disorder is a chronic disease, so that the patient responsible for medical treatment, appropriate to continue therapy. This should match the minimum effective dose, and periodically evaluate the appropriateness of the continuation of maintenance therapy.
Treatment sertralinom Generic Zoloft posttraumatic stress disorder

In connection with emergencies in the modern world, a growing number of violations, known as «post-traumatic stress disorder» (PTSD). PTSD (according to the criteria DSM-III-R/IV) develops in response to travmatiziruyuschee event that involves threat of death or serious injury, threat of physical damage to the person or other people and the response of intense fear, helplessness or horror.

Symptoms resulting from travmatiziruyuschego events include re-experience the events in the form of intrusive thoughts, dreams, or flashes, intense physiological distress, and physiological reactions to memories of the event, avoidance of situations reminiscent of travmatiziruyuschem event, inability to recall the details and / or reduction general reactivity in the form of reduced interest in the important cases, alienation from others, restricted affect, or feeling a lack of future, the initiation of vegetative symptoms, including insomnia, increased skittishness, the violation of concentration, irritability, or an outbreak of anger. The diagnosis of PTSD requires persistence of symptoms for at least a month and the presence of significant distress or violation of social, occupational or other activity.

Sertralin Generic Zoloft is used for the treatment of PTSD. The effectiveness of the drug with PTSD has been established in several placebo-controlled studies [Brady K et all, 2000]. When maintenance therapy should periodically assess the appropriateness of its continuation.

Application Setralin Generic Zoloft elderly and patients with somatic Pharmacotherapy in the elderly is a great difficulty in mind the high risk of developing complications from the treatment. The use of antidepressants in this category of patients requires special caution.

The high profile security Setralin Generic Zoloft makes it attractive for use in gerontology. Comparative studies Setralin Generic Zoloft with amitriptyline, nortriptilinom fluoxetin and demonstrated its high efficacy and relative safety of this category of patients [Thompson C., 1992].

In recent years certralin Generic Zoloft have been applied in obschesomaticheskih disorders, in particular, in patients post-myocardial infarction.

More recently, patients with cardiovascular disorders excluded from any study antidepressants because of their cardiotoxicity and the potential risk of undesirable interactions of antidepressants and kardiotropnyh drugs.

Sertralin Generic Zoloft has proved safe in this regard and are well tolerated by these patients. Most revealing in this regard is the study SADHART [Glassman A., 2002], which studied patients with severe depression and myocardial infarction in the acute period (30 days) or post-attack of coronary disease.

The study was multicentered placebo-controlled, double-blind and lasted 24 weeks. The average age of patients was 57 years old, dose - 50-200 mg / day. Sertralin Generic Zoloft had 186 patients a placebo - 183. Almost all patients received the usual set of kardiotropnyh drugs. The study showed that sertralin Generic Zoloft was significantly more effective than placebo. At the same side effects in both groups hardly differed in frequency and severity of manifestations. In patients receiving sertralin Generic Zoloft, from the side effects are diarrhea was presented. The authors conclude on the efficacy and safety Setralin Generic Zoloft for cardiac patients with depression.

Another study examined the effectiveness of Setralin Generic Zoloft in 38 depressed patients post myocardial infarction. Patients received 50 mg Zolofta day. 27 patients completed the study, and none of them have not seen any side effects. The authors confirmed the assumption that sertralin Generic Zoloft contributed to the restoration of cardiac function in depressed patients after a heart attack [Parissis, 2007].

Effectiveness and safety Setralin Generic Zoloft was demonstrated in the study of Rasmussen et al [2003], which applied sertralin Generic Zoloft for the purpose of preventing the development of depression in patients with stroke. 138 patients were studied for 12 months. Sertralin Generic Zoloft has demonstrated a significant advantage over placebo in this component of the study, as well as positively influence the improvement of cognitive functions of patients.

In the group of patients who received sertralin Generic Zoloft, there were lower numbers of blood pressure, decreased tachycardia.

Application Setralin Generic Zoloft in chronic pain Antidepressants are effective means kupirovaniya chronic pain of different origin and have not only analgetics action, but also significantly reduce the accompanying emotional (affective) reaction, ie facilitate the experience of pain and suffering to the patient.

Indeed, following the reduction in pain usually appears clear and psychotropic effect: improved mood, enhanced performance, recover interest disappears fobicheskaya symptoms (worrying anticipation of pain). Changing the very perception of pain and attitudes towards it - it becomes more efficient, eliminates its affective saturation. There is a gradual distancing from the identity of pain, which allows to increase its protective mechanisms and adaptive capacity.

Antinotseptivnye properties of the antidepressants were discovered almost immediately after its introduction into psychiatric practice. During the 40-year history of their use was to do a large number of open and controlled studies proving their effectiveness, with chronic, organic pain syndromes of different etiologies, including those resistant to conventional analgetics funds.

Theoretically antinotseptivny antidepressants may have an effect on the three main mechanisms: redutsiruya depression, potentsiruya Effects of exogenous or endogenous analgetics substances because of their own analgetics properties. The latter fact is confirmed by data obtained in the experimental study in animals and in humans, indicating that antidepressants increase the threshold of pain sensitivity and have antinotseptivny effect of direct exposure to the opiate receptors.

However, it remains unclear whether the stimulation of opiate receptors primarily or indirectly, through activation noradrenergicheskih and serotoninergicheskih neurons. Modern theories of endogenous pain control require involvement of the two systems NEUROMEDIATOR (noradrenergicheskoy and serotoninergicheskoy).

Therefore, for treatment of chronic pain used primarily tricyclic antidepressants or SIOZSN. However, in some cases, a good effect can be achieved with the use of drugs that affect mainly to serotoninergicheskuyu system. Operations were performed, which showed high efficiency Setralin Generic Zoloft in the treatment of tension headache, pain dysfunction syndrome temporomandibular mandibular joint with the muscular-fascial pain syndrome, with pain in women in the pelvic area and even in the diabetic polineyropatii [Gustaw K. , 2000; Engel CC Jr, 1998; Goodnick P.J., 1997].
Application certralina Generic Zoloft can be seen especially in cases where the patient is not receiving transfers, or the effect of amitriptyline previous therapy (including amitriptyline) was insufficient.
However, recommendations for the use of Zolofta with pain syndromes in the general medical practice requires additional, more extensive studies that have confirmed the effectiveness of certralina found in chronic pain.
Other uses
certralina Generic Zoloft
Violation of ejaculation is one of the most common sexual disorders among men. Missing data (controlled clinical research) that would prove the effectiveness of psychotherapy in the normalization of sexual function in these patients. Now there is increasing interest, both by doctors and pharmaceutical companies to the possible pharmacological treatment of this violation.

We know that one of the side effects certralina Generic Zoloft is delayed ejaculation. In the study, McMahon CG, Samali R. (1999) have shown that the use of certralina Generic Zoloft in men with premature ejaculation had a normalizing effect on sexual function. There is also a description of the successful application of certralina Generic Zoloft in a patient with frontal-temporal dysfunction, which manifests itself in an extremely sexual desire with the serious, aggressive sexual harassment to the wife. Receive certralina Generic Zoloft Normalized behavior and sexual function in this patient [Anneser JM, 2007].
Metering mode
Zoloft is available in tablets of 50 and 100 mg. Standard dose - 50 mg per day. Zoloft designate once a day - morning or evening. Depending on individual sensitivity to the drug and the other reading a range of doses in adults and adolescents can vary from 50 to 200 mg / day., In children from 6 to 12 years - from 25 to 200 mg / day.

In patients with dysfunction of the liver should reduce the dose or a multiplicity of use of the drug. Older people recommend the same dose as adults. However, given the frequent greater sensitivity of older people to drugs in general, it is advisable to initiate treatment with lower doses than in younger people.
Undesirable effects
As indicated above, the selectivity of action Zolofta to reverse the seizure of serotonin and the lack of affinity for adrenergic, cholinergic, and serotoninovym benzodiazepinovym postsinapticheskim receptors define a low frequency of development of certain undesirable events that may mediate these neuromediators. Nevertheless, it is necessary to know the possible complications that may arise when applying Zolofta to warn of the possibility of the emergence of the patient and take action to overcome them.
Unwanted effects in the application Zolofta may include:
• Violations of the autonomic nervous system (disorder ejaculation, dry mouth, sweating);
• Violations of the central and peripheral nervous system (somnolence, tremor);
• general (fatigue);
• gastrointestinal disorders (anorexia, constipation, diarrhea, or erratic stools, dyspepsia, nausea);
• psychiatric disorders (agitation, anxiety, insomnia, decrease in libido).

The children, moreover, when applying Zolofta may arise giperkineziya, tick fever, malaise, purpura, reducing body weight, a violation of concentration, manicheskie reaction, emotional lability, a breach of thinking, and bleeding from the nose.
What should the doctor tell
patients taking Zoloft?
Do not expect a rapid onset of effect of taking the medication. Symptoms of depression and a reduced interest in life is usually held within 4-6 weeks after the start of taking the medication. Reducing some of the somatic symptoms and normalization of sleep may occur earlier, within 1-2 weeks after the start of taking the medication before a measurable improvement in mood or interest in any activity. This may be an indication that the therapy will be effective.

Nevertheless, following a tangible improvement of therapy should be continued. Before you judge the effectiveness of the drug against depression, Zoloft should be taken at least 2 months. You can not stop the self, or alter the dose of medication. A sudden withdrawal of taking the medication could lead to one and / or more of the following symptoms lifting: irritability, nausea, dizziness, vomiting, nightmares, headaches, and paresthesia. Zoloft normally be taken 1 time a day. Tablets can be taken during meals. At the beginning of taking the medication may cause some side effects.

The most frequently increased sweating, drowsiness, nausea, diarrhea, tremor, dry mouth, loss of strength, headache, decrease, or a set of weight, dizziness and anxiety. These side effects are generally slight or moderate and usually go through 1-2 weeks while continuing taking the medication. It may be a worsening of sexual function when receiving Zolofta.
Thus, the emergence of a new class of antidepressants - SIOZS - the possibility of more widespread use of antidepressants, not only in mental health, but also obschemeditsinskoy practice. One of the members of this group is the drug sertralin Generic Zoloft, which has high efficiency with a broad spectrum of depressive violations, which are typical for a large number of patients seeking treatment to the doctor about somatic complaints. The high profile of security and ease of use of sertralin Generic Zoloft is an effective drug.

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