Sertraline - A review of its therapeutic use in post-traumatic stress disorder

Sertraline is a selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitor (SSRI) that inhibits the serotonin transporter with only minor inhibition of the noradrenaline (norepinephrine) and dopamine transporters. It has recently shown efficacy in most, although not all, clinical trials in patients with post-traumatic stress disorder (PTSD). In 2 of 3 randomised, double-blind trials in civilian patients, once daily oral sertraline 50 to 200mg significantly reduced symptoms of PTSD compared with placebo over 12 weeks. Response rates were 53 and 60% for sertraline compared with 32 and 39% for placebo. The quality of life of patients receiving sertraline was significantly improved compared with those receiving placebo in 1 trial. Post-hoc subgroup analysis of pooled results from the 2 trials showed that sertraline has significant efficacy in women with PTSD but efficacy in men was not clearly established. The efficacy of sertraline in combat-induced PTSD has not been clearly established. Sertraline has shown efficacy in 2 longer-term trials of 24 (nonblind, noncomparative) and 28 (double-blind, placebo-controlled) weeks' duration. Sertraline is generally well tolerated. Adverse events associated significantly mon frequently with sertraline than placebo in clinical trials of patients with PTSD were insomnia. diarrhoea and nausea. Discontinuation of treatment occurred in approximately the same number of sertraline- and placebo-treated patients. Conclusions: Sertraline has demonstrated efficacy in the treatment of PTSD, particularly in female patients and in non-combat-induced PTSD, and is generally well tolerated. It appears to have a lower potential for drug interactions than other SSRIs, although direct comparisons are lacking. Sertraline is currently the only SSRI approved for the treatment of PTSD. As SSRIs are recommended as the first-line pharmacological agents when drug treatment is indicated in patients with PTSD, sertraline may be considered the present drug of choice for PTSD, particularly in females from the civilian population.