Sertraline

INTRODUCTION

Indications

Major depressive disorder. Panic disorder. Obsessive-compulsive disorder (OCD). Posttraumatic stress disorder (PTSD). Social anxiety disorder (social phobia). Premenstrual dysphoric disorder (PMDD). Unlabeled Use: Generalized anxiety disorder (GAD).

Action

Inhibits neuronal uptake of serotonin in the CNS, thus potentiating the activity of serotonin. Has little effect on norepinephrine or dopamine. Therapeutic Effects: Antidepressant action. Decreased incidence of panic attacks. Decreased obsessive and compulsive behavior. Decreased feelings of intense fear, helplessness, or horror. Decreased social anxiety. Decrease in premenstrual dysphoria.

Adverse Reactions/Side Effects

CNS: NEUROLEPTIC MALIGNANT SYNDROME, SUICIDAL THOUGHTS, dizziness, drowsiness, fatigue, headache, insomnia, agitation, anxiety, confusion, emotional lability, impaired concentration, manic reaction, nervousness, weakness, yawning. EENT: pharyngitis, rhinitis, tinnitus, visual abnormalities. CV: chest pain, palpitations. GI: diarrhea, dry mouth, nausea, abdominal pain, altered taste, anorexia, constipation, dyspepsia, flatulence, ↑ appetite, vomiting. GU: sexual dysfunction, menstrual disorders, urinary disorders, urinary frequency. Derm: ↑ sweating, hot flashes, rash. F and E: hyponatremia. MS: back pain, myalgia. Neuro: tremor, hypertonia, hypoesthesia, paresthesia, twitching. Misc: SEROTONIN SYNDROME, fever, thirst.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for signs of neuroleptic malignant syndrome, including hyperthermia, diaphoresis, generalized muscle rigidity, altered mental status, tachycardia, changes in blood pressure (BP), and incontinence. Symptoms typically occur within 4–14 days after initiation of drug therapy but can occur at any time during drug use. Report these signs to the physician immediately.

• Monitor and report signs of serotonin syndrome, including hyperthermia, rigidity, myoclonus, and autonomic instability with fluctuating vital signs and extreme agitation that may proceed to delirium and coma. Patients should not take sertraline with other drugs that increase serotonin levels (e.g., MAO inhibitors).

• Be alert for increased depression and suicidal thoughts and ideology, especially when initiating drug treatment, and in children and teenagers. Notify physician or other mental health care professional immediately if patient exhibits worsening depression.

• Inform physician if patient demonstrates other mood changes such as increased anxiety, agitation, impaired memory, impaired concentration, emotional lability, manic reactions, or confusion (See Appendix D).

• Monitor symptoms of chest pain and palpitations, especially during exercise. Report severe or prolonged cardiac symptoms.

• Assess any back pain or muscle pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug-induced rather than caused by anatomic or biomechanical problems.

• Assess paresthesias (numbness, tingling), tremor, twitching, or changes in muscle tone. Perform objective tests, including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

• Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers ...