Skip to main content
SpringerLink
Log in

Spotlight on Sertraline in the Management of Major Depressive Disorder in Elderly Patients

  • Adis Spotlight
  • Published:
CNS Drugs Aims and scope Submit manuscript

Abstract

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-Åsberg 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, 1 This spotlight is derived from abstract and summary text of an Adis Drug Evaluation originally published in Drugs & Aging 2002; 19 (5): 377-92. 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Murdoch D, McTavish D. Sertraline: a review of its pharmaco-dynamic and pharmacokinetic properties, and therapeutic potential in depression and obsessive-compulsive disorder. Drugs 1992 Oct; 44(4): 604–24

    Article  PubMed  CAS  Google Scholar 

  2. Perry CM, Benfield P. Sertraline: an overview of its pharmacological properties and a review of its therapeutic efficacy in obsessive-compulsive disorder. CNS Drugs 1997; 7(6): 480–500

    Article  CAS  Google Scholar 

  3. DeVane CL. Differential pharmacology of newer antidepressants. J Clin Psychiatry 1998; 59 Suppl. 20: 85–93

    Google Scholar 

  4. Casacchia M, Pollice R, Matteucci M, et al. Brain serotonin and the mechanism of action of selective serotonin re-uptake inhibitors (SSRI). Arch Gerontol Geriatr 1998; 27 Suppl. 6: 65–70

    Article  CAS  Google Scholar 

  5. Nutt DJ, Forshall S, Bell C, et al. Mechanisms of action of selective serotonin reuptake inhibitors in the treatment of psychiatric disorders. Eur Neuropsychopharmacol 1999 Jul; 9(Suppl. 3): 81–6

    Article  Google Scholar 

  6. Lane RM, O’Hanlon JF. Cognitive and psychomotor effects of antidepressants with emphasis on selective serotonin re-uptake inhibitors and the depressed elderly patient. Ger J Psych 1999; 2(1): 1–28

    Google Scholar 

  7. Schloss P, Williams DC. The serotonin transporter: a primary target for antidepressant drugs. J Psychopharmacol 1998; 12(2): 115–21

    Article  PubMed  CAS  Google Scholar 

  8. MacQueen G, Born L, Steiner M. The selective serotonin reuptake inhibitor sertraline: its profile and use in psychiatric disorders. CNS Drug Rev 2001 Spring; 7(1): 1–24

    Article  PubMed  CAS  Google Scholar 

  9. Pfizer US. Zoloft (sertraline) full prescibing information [online]. Available from URL: http://www.zoloft.comx [Accessed Jan 2002]

  10. Owens MJ, Knight DL, Nemeroff CB. Second-generation SSRIs: human monoamine transporter binding profile of escitalopram and R-fluoxetine. Biol Psychiatry 2001 Sep 1; 50(5): 345–50

    Article  PubMed  CAS  Google Scholar 

  11. Bondareff W, Alpert M, Friedhoff AJ, et al. Comparison of sertraline and nortriptyline in the treatment of major depressive disorder in late life. Am J Psychiatry 2000 May; 157(5): 729–36

    Article  PubMed  CAS  Google Scholar 

  12. Newhouse PA, Krishnan KRR, Doraiswamy PM, et al. A double-blind comparison of sertraline and fluoxetine in depressed elderly outpatients. J Clin Psychiatry 2000 Aug; 61(8): 559–68

    Article  PubMed  CAS  Google Scholar 

  13. Hindmarch I, Shillingford J, Shillingford C. The effects of sertraline on psychomotor performance in elderly volunteers. J Clin Psychiatry 1990 Dec; 51Suppl. B: 34–6

    PubMed  Google Scholar 

  14. Mattila MJ, Saarialho-Kere U, Mattila M. Acute effects of sertraline, amitriptyline, and placebo on the psychomotor performance of healthy subjects over 50 years of age. J Clin Psychiatry 1988 Aug; 49Suppl.: 52–8

    PubMed  Google Scholar 

  15. Ronfeld RA, Tremaine LM, Wilner KD. Pharmacokinetics of sertraline and its N-demethyl metabolite in elderly and young male and female volunteers. Clin Pharmacokinet 1997; 32(Suppl. 1): 22–30

    Article  PubMed  CAS  Google Scholar 

  16. Ronfeld RA, Wilner KD, Baris BA. Sertraline: chronopharmacokinetics and the effect of coadministration with food. Clin Pharmacokinet 1997; 32(Suppl. 1): 50–5

    Article  PubMed  CAS  Google Scholar 

  17. Catterson ML, Preskorn SH. Pharmacokinetics of selective serotonin reuptake inhibitors: clinical relevance. Pharmacol Toxicol 1996 Apr; 78(4): 203–8

    Article  PubMed  CAS  Google Scholar 

  18. van Harten J. Clinical pharmacokinetics of selective serotonin reuptake inhibitors. Clin Pharmacokinet 1993 Mar; 24(3): 203–20

    Article  PubMed  Google Scholar 

  19. Xu Z-H, Wang W, Zhao X-J, et al. Evidence for involvement of polymorphic CYP2C19 and 2C9 in the N-demethylation of sertraline in human liver microsomes. Br J Clin Pharmacol 1999 Sep; 48(3): 416–23

    Article  PubMed  CAS  Google Scholar 

  20. Demolis J-L, Angebaud P, Grange J-D, et al. Influence of liver cirrhosis on sertraline pharmacokinetics. Br J Clin Pharmacol 1996 Sep; 42(3): 394–7

    Article  PubMed  CAS  Google Scholar 

  21. Preskorn SH. Outpatient management of depression: a guide for the practioner [online]. Available from URL: http://www.preskorn.com/books [Accessed 2002 May 2]

  22. Preskorn SH. Clinically relevant pharmacology of selective serotonin reuptake inhibitors, an overview with emphasis on pharmacokinetics and effects on oxidative drug metabolism. Clin Pharmacokinet 1997; 32 Suppl. 1: 1–21

    Article  Google Scholar 

  23. Schneider LS, Clary CM, Finkel SI, et al. Sertraline in the treatment of elderly depression: results of a large, multicenter, placebo-controlled trial [abstract/poster]. 153rd Annual Meeting of the American Psychiatric Association; 2000 May 13–18; Chicago, 134-5

  24. Cohn CK, Shrivastava R, Mendels J, et al. Double-blind, multi-center comparison of sertraline and amitriptyline in elderly depressed patients. J Clin Psychiatry 1990 Dec; 51Suppl. B: 28–33

    PubMed  Google Scholar 

  25. Forlenza OV, Almeida OP, Stoppe Jr A, et al. Antidepressant efficacy and safety of low-dose sertraline and standard-dose imipramine for the treatment of depression in older adults: results from a double-blind, randomized, controlled clinical trial. Int Psychogeriatr 2001 Mar; 13(1): 75–84

    Article  PubMed  CAS  Google Scholar 

  26. Finkel SI, Richter EM, Clary CM, et al. Comparative efficacy of sertraline vs. fluoxetine in patients age 70 or over with major depression. Am J Geriatr Psychiatry 1999 Summer; 7(3): 221–7

    PubMed  CAS  Google Scholar 

  27. Finkel SI, Richter EM, Clary CM. Comparative efficacy and safety of sertraline versus nortriptyline in major depression in patients 70 and older. Int Psychogeriatr 1999 Mar; 11(1): 85–99

    Article  PubMed  CAS  Google Scholar 

  28. Sheikh J, Doraiswamy P, Clary C, et al. Late-life depression and medical comorbidity: implications for treatment response. Int Psychogeriatr 2001; 13Suppl.2: 180S

    Google Scholar 

  29. Sheikh J, Doraiswamy P, Clary C, et al. Therapeutic response to sertraline in medically depressed elderly [poster P-124]. Tenth Congress of the International Psychogeriatric Association; 2001 Sep 9–14; Nice

  30. Lyketsos CG, Sheppard J-ME, Steele CD, et al. Randomized, placebo-controlled, double-blind clinical trial of sertraline in the treatment of depression complicating Alzheimer’s disease: initial results from the Depression in Alzheimer’s Disease Study. Am J Psychiatry 2000 Oct; 157(10): 1686–9

    Article  PubMed  CAS  Google Scholar 

  31. Taylor IC, McConnell JG. Severe hyponatraemia associated with selective serotonin reuptake inhibitors. Scott Med J 1995 Oct; 40(5): 147–8

    PubMed  CAS  Google Scholar 

  32. Kirby D, Ames D. Hyponatraemia and selective serotonin reuptake inhibitors in elderly patients. Int J Geriatr Psychiatry 2001; 16(5): 484–93

    Article  PubMed  CAS  Google Scholar 

  33. Bradley ME, Foote EF, Lee EN, et al. Sertraline-associated syndrome of inappropriate antidiuretic hormone: case report and review of the literature. Pharmacotherapy 1996; 16(4): 680–3

    PubMed  CAS  Google Scholar 

  34. Barbey JT, Roose SP. SSRI safety in overdose. J Clin Psychiatry 1998; 59 Suppl. 15: 42–8

    Google Scholar 

  35. Veterans Health Administration. Practice guideline for the management of major depressive disorder in adults [online]. Available from URL: http://www.oqp.med.va.gov/cpg [Accessed 2002 Sep 20]

  36. Leonard BE. Pharmacological differences of serotonin reuptake inhibitors and possible clinical relevance. Drugs 1992; 43 Suppl. 2: 3–9, discussion 9-10

    Article  Google Scholar 

  37. Solai LK, Mulsant BH, Pollock BG. Selective serotonin reuptake inhibitors for late-life depression: a comparative review. Drugs Aging 2001; 18(5): 355–68

    Article  PubMed  CAS  Google Scholar 

  38. GlaxoSmithKline. Paxil (paroxetine) full prescribing information (US) [online]. Available from URL: http://www.gsk.com [Accessed Feb 2002]

  39. Forest Pharmaceuticals. Celexa (citalopram) full prescribing information (US) [online]. Available from URL: http://www.celexa.com [Accessed Feb 2002]

Download references

Acknowledgements

The full text article in Drugs & Aging 2002; 19 (5): 377-92 was reviewed by: I.M. Anderson, Neuroscience and Psychiatry Unit, University of Manchester, Manchester, United Kingdom; G. De Sarro, Department of Experimental and Clinical Medicine, Faculty of Medicine and Surgery, University of Cantanzaro, Cantanzaro, Italy; S.I. Finkel, Leonard Schanfield Research Institute, Council for Jewish Elderly, Chicago, Illinois, USA; O.V. Forlenza, Laboratory of Neuroscience, Institute of Psychiatry, University of Säo Paulo, Säo Paulo, Brazil; C.G. Gottfries, University Hospital, Molndal, Sweden; I. Kurzthaler, University of Innsbruck, Innsbruck, Austria; S.H. Preskorn, School of Medicine, Department of Psychiatry, University of Kansas, Wichita, Kansas, USA.

Author information

Authors and Affiliations

  1. Adis International Limited, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, Auckland 10, New Zealand

    Richard B.R. Muijsers, Greg L. Plosker & Stuart Noble

Authors
  1. Richard B.R. Muijsers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Greg L. Plosker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stuart Noble
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stuart Noble.

Additional information

This spotlight is derived from abstract and summary text of an Adis Drug Evaluation originally published in Drugs & Aging 2002; 19 (5): 377–92

Rights and permissions

Reprints and permissions

About this article

Cite this article

Muijsers, R.B., Plosker, G.L. & Noble, S. Spotlight on Sertraline in the Management of Major Depressive Disorder in Elderly Patients. Mol Diag Ther 16, 789–794 (2002). https://doi.org/10.2165/00023210-200216110-00011

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00023210-200216110-00011

Keywords

Search

Navigation