Talk:Sertraline/Archive 1

Panic disorder section
"Double-blind comparative studies found sertraline to have the same effect on panic disorder as paroxetine (Paxil)[65] or the gold standard of panic disorder treatment alprazolam (Xanax).[66]" Determining whether alprazolam is "the gold standard of panic disorder treatment" would require an entire article of its own, which would then be removed for overabundance of opinion. (In my opinion.)

Dates
Something is innacurate about this article- it says that Brittain banned zoloft for use in minors in 2003 in one part of the article and 2004 in another. It also says that it was only approved for use in minors in the USA in 2003- This needs to be double checked. --72.19.81.122 02:10, 21 September 2006 (UTC)

Generic Side Effects Versus Name Brand
Interesting fact: When I last had my prescription renewed by my doctor (a few months ago), she advised me that although there was now a generic for Zoloft available, I shouldn't switch to it unless there's a critical need. She stated that she's experienced with several other patients that the generic does not always have the same effects as the name brand, despite the fact that they should be the same. When I brought this up with my mother, who had recently made the switch to the generic without her doctor advising her of these potential side effects (reducing the potential for suggestion-induced placebo), she confirmed that the effects were not the same when switching to the generic. Additionally, she mentioned that the generic has a different coating, such that it starts melting on the tongue, causing a bad taste as opposed to the name brand of Zoloft. This does not seem to be relegated simply to generic Sertraline, either; I have hearsay evidence that for some people, the generic of Levoxyl (Levothyroxine) functions differently versus the name brand as well.

Another client remarks: I totally agree that the generic 100 mg Sertraline DOES NOT WORK the same as Zoloft. I switch from Zoloft about 2 months ago and have started a down-hill slide towards depression. It wasn't until this morning that it dawned on me when this started. I called my pharmacist and told him I no longer wanted the Sertraline, I want the regular Zoloft because it works for me. Even though I can't really afford the double in price -- what are my options? Suicide is NOT AN OPTION!


 * This is supposed to be a forum for discussion of the article, not the subject, but that aside... I've heard stuff before about the generic being different from the name brand.  www.crazymeds.us/BvsG.html This page at Crazymeds.us, while casual in tone and written by a non-professional, has links to some laws and studies about differences in bioavailability of brand and generic meds (in the US, a generic is allowed to be up to 20% more or less bioavailable than the brand name drug).  I think it's important to note that while a brand and a generic may (or may not) be different, it's possible that for some people the generic will work better.  Also, for some drugs (sertraline only went off patent recently, so I'm not sure about it) there are multiple manufacturers of generics, so you can try asking your pharmacist if you can switch to a different one.  Failing that, I guess you could try a different SSRI that's cheaper (fluoxetine/Prozac and paroxetine/Paxil are both available in generic form in the US), or see if your doctor has samples of Zoloft or another SSRI.  Good luck. --Galaxiaad 00:57, 8 February 2007 (UTC)
 * I wish I was providing a link, but there is a study that found that medicine that costs more works better (that being the only variable in the study).12.192.132.130 (talk) 23:17, 7 August 2008 (UTC)

Hello, I am a long time contributor to wikipedia but this is my first post to a discussion forum as a registered user, so I apologize for not using correct formatting and style etc. My concern in this wiki is the lack of sources behind sources. Are there an experts on the subject that are willing to contribute? —Preceding unsigned comment added by Christopher.hawken (talk • contribs)

There are several people having serious effects from the generic versions of Zoloft (Teva, Greenstone) since taking them. See

http://www.topix.net/forum/business/healthcare/T7R9P0NFHGN871B8J/

The only plausible explanations for generics meds to work differently from name-brands are 1) coating and digestion issues: some people may be less able to digest the pill coatings from different manufacturers, and 2) the medication's benefits were entirely due to placebo effect. In either case it is not worth alarming potential users over the use of generics. I agree the article does not need this added.

Random Comments
In the section concerning side effects: the part about increased incidence of suicidal thoughts and behaviour being questionable does not seem to be accurate. That data was assembled from double-blind tests where some depressed people (of various degrees of severity) were given Sertraline and others were given placeabos. It was found that while both groups exhibited a higher rate of suicidal behavior / actual suicides than the general population, the group taking Sertraline had a rate of suicide that was higher, and by a statistically significant margin. For this reason, physicians have been urged by the US's FDA to exercise caution when considering the prescription of Sertraline (and indeed all SSRI's) to patients who are exhibiting suicial thought patterns and/or who have a history of attempting and/or threatening to kill themselves (and/or others.) It is not known how or why these patients are apparantly made more suicidal when taking SSRI's, but some people have suggested that it may have to do with the way different individuals metabolize the SSRI's.  It does not seem to be the case that a person who has a history of depression but no history of suicidal behaviour becomes more likely to exhibit such behaviours while taking SSRI's.  -Random Bloke


 * Question for Random Bloke: How do you suppose a chemical can put complex thoughts ( commit suicide, write a novel, dance the rhumba, whatever ) into a patient's mind?  Considering whether or not that seems possible might lend weight to the answer of whether this is a statistical hiccup or not.  FireWeed 23:18, 22 January 2007 (UTC)


 * I don't think he's saying it can put the thoughts in there; as I understand some of the current thinking, the Sertraline may enable previously-unmotivated folks to act on suicidal thoughts that have been lingering for a long time, unacted upon.

Apart from their self esteem being shot to shit when they read up on the drugs they have become dependent on. No one seems to realise how FUCKING HORRIBLE it is to be on a drug that makes you dizzy, takes away your ability to orgasm, gives you heart palpitations and pins and needles and muscle twitches, but DOESN'T actually make you better. And then when you go off the drug all of it gets worse. And then they tell you it's non-addictive and you're overreacting and you should TAKE MORE. Fuck that! Ragnarokmephy 03:04, 22 January 2007 (UTC)


 * Have you ever considered that your experience isn't representative? I'm really sorry you have suffered through all this. Josephgrossberg 16:11, 22 January 2007 (UTC)


 * Yeah. I react pretty badly to this drug. The problem is a lot of doctors are so wrapped up in "man this chemical receives good feedback from Test Group A" they ignore the guy in Test Group B who's still curled in the foetal position listening to Hawthorne Heights. (ew) Ragnarokmephy 05:33, 24 January 2007 (UTC)


 * Hey, there's plenty of SSRIs out there. Your side effects range from somewhat frequent to infrequent. The most common side effects are worth dealing with at the result of getting rid of the mental disorder, but in your case (more infrequent side effects), you could switch medicines if they're that annoying. The fact that the medicine isn't working alone means you should simply switch (or give it more time, assuming you haven't already). And you really shouldn't let the internet determine your self-esteem when concering the drug (or any drug for that matter), ESPECIALLY Wikipedia. I hope you haven't done this. This article is so negative, it could plant the idea inside someone's head that if they took Zoloft, they'd have a lifelong erection, be vomiting in their sleep, and have a 300% increase of their disorder's symptoms. The article fails to mention that most side effects are INFREQUENT or RARE. I saw one mention of something being "uncommon" (PSSD I think, which obviously is uncommon). I mean, if medicine works, it works...but I'm sure no help comes from a pessimistic attitude. The article sure has hell discouraged me a bit....but not much really (remember, Wikipedia folks!). P.S. Emo definitely won't help. 67.186.151.231 04:53, 28 April 2007 (UTC)

Not sure where to put this, but it seems to me from the abstracts of citations 100 and 101 that they say the same thing: that sertraline is effective when used to treat GAD. However, the article claims that citation 101 showed that it is only marginally useful. Samizzo (talk) —Preceding undated comment was added at 14:52, 24 December 2008 (UTC).

Talk
How come someone keeps deleting the article in external links that is a full-text medical article on how Zoloft.com provides misleading information? It's on the mechanism of Zoloft how could it be irrelevant, and it's provided as an external link?

it seems that some fans of antidepressants on here are really unwilling to allow critical information to be provided even in external links so that people can make up their own minds and that seems really unfair.

The article is at http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0020392, I keep putting it external links, and it keeps getting zapped. I don't see any reason why this article couldn't be linked to pages for each of the SSRIs that the article mentions as well as for SSRIs in general.


 * Well, I do. The article addresses the SSRIs as a group. You have been blasting that link onto 20-30 Wikipedia pages. This is annoying and distracting. Please stop. JFW | T@lk  22:29, 20 November 2005 (UTC)

It seems SSRIs tend to attract plenty of arguements because whether or not they work varies from person to person. For many people they can cause a great improvement, for some others, much harm. The details of this have been well studied and documented; in the medical world, both the pros and cons are well known. Of course, some of the people who were not treated well by Sertraline have taken a vendetta against it, and will not rest until the pill has been banned, or everybody has been warned against it. Others, whose mental health was saved by it, will rush to it's defense. Flame warriors: you do not need to change the article to alert the masses The medical community is aware of the risks associated with this and other medications of this type. Just because Medication X ended up making you feel like a zombie does not mean there is a global conspiracy to turn people into zombies. Stop adding to the list of side effects everything that happened to you while taking it. You do not need to add your own scientific discoveries. You snorted Wellbutrin and you think it worked better than swallowing? Great, tell all your Myspace friends, and keep it out of here. People should take benzos if they have too much psychic energy, you say? Gee, somebody better alert the American Psychiatric Association, they still think our brains are made of neurons. Here's a simple guidline to anyone taking it upon themselves to edit a medical article-          if you aren't citing a well accepted, peer-reviewed source, you aren't being helpful! --72.19.81.122 06:23, 3 October 2006 (UTC)

Beware of this Editor
This editor thinks he is a Crusader protecting drug information. What is needed is balanced information, not one editor deleting anything negative about a drug entry which is what this fellow seems to do as well as dissing Wikipedia itself. Yes, he's right about using reliable sources,but the medical community is not always as well informed as it should be, and there are opposing scientific studies presented about particular drugs. When a drug is under a black box alert, it is responsible for knowledgeable editors to provide useful information so that readers are well informed. Since this editor has already proposed elsewhere that readers not use wikipedia as a reliable source for any information on drugs, he should now cease to do ANY editing in that area. There are many very capable editors who are knowledgeable in this area, as in other areas, as shown by the quality of the articles comprising Wikipedia. I recently read a review of Wiki that stated it was of amazing good quality even when compared to known encyclopaedias. It is certainly more up-to-date than printed encyclopaedias that are years out of date by the time they are printed.Any reader who has special interest in a drug can also research this drug through the internet accessing many different resources. I think anyone who does this will likely find that the Wikipedia entries are actually very good. —Preceding unsigned comment added by Szimonsays (talk • contribs)

Agreed
If somebody doesn't like what they read in Wikipedia, then they're free to get their information elsewhere, and just with the internet the size that it is, there are a lot of resources about literally everything. To my knowledge, Wikipedia is supposed to function as a free, online encyclopedia based on facts, not a single user's opinion, or an engine geared at protecting (or attacking) any certain entity so that said entity can benefit (advertising?) or suffer (mud slinging?). When opinions are presented, they are supposed to be backed up with references/studies/etc in the same fashion World Book or Encyclopædia Britannica would generally go by. Correct me if I'm wrong... jeff (talk) 22:10, 9 June 2008 (UTC)

Obvious Questions
Who developed it? When? Is it patented? When does the patent expire? Etc.


 * It is very interesting issue. It seems sertraline is a generic drug, because e.g. Slovenian pharmaceutical company Krka is selling sertraline hydrochloride tablets under trade name Asentra, and Pliva is (or was) selling it even under the name Sertraline. But there is Pfizer's patent on sertraline which expires in December 2005, and there is another sertraline patent which expires in 2010... I'm confused. Maybe it has something to do with polymorphism. Mykhal 21:51, 30 Oct 2004 (UTC)

in australia, all of the tablets are the same colour, white
 * here in Europe, too -Arny 02:13, 18 April 2006 (UTC)

suggestion for addition to Sertraline page
The adverse effects listing in the third paragraph omits a major one: sexual side effects, which is a major complaint with most of the SSRIs.
 * Done. Eldereft

BTW, Canada also sells Sertraline (generic) in 50- and 100-mg capsules. The patents must apply on a country by country basis.

Another side effect is a tightness/discomfort in the throat; which can be a symptom of increased anxiety.

The adverse effects listing in the third paragraph omits a minor one: increased sweating. I use the drug and since then this has subsided, but in the sheets the pharmacy gave me along with sertraline "increased sweating" is listed. From personal experience (I am unsure who should be credited with this info; it is reported on various websites as well), during the "insomnia" phase while my body was adapting to its use (apparently), I would wake up very sweaty, from the first night I took it and decreasing afterward.

Setraline is sold in Australia, like it says, but in only white tablets. A few different generic names for it here like Concorz from Hexal, but you can of course get Zoloft itself. Pfizer sends Zoloft trial packs to doctors to give to patients, in the hope that the patient will want to continue using the same brand.

Another theory about the correlating suicide rate with antidepressant usage is that users feel the drugs were unsuccessful at curing their depression, and extrapolated that into there being "no" cure.

Why not post information about a less talked about side effect, "smelly farts"

Dopamine
It is mentioned in the article that sertraline also works on dopamin in high doses. So far I haven't found any source to confirm it, although I accept it is probably true since I've already heard that before. However, there should be a citation or link or something to confirm that. Arny 02:17, 18 April 2006 (UTC) P.S. And how high are those "high" doses? Some milligrams would be informative here...
 * Ok, I've finally found a medical article with some info about this and will add it to the article. --Arny 14:59, 1 May 2006 (UTC)

"Evidence against Effectiveness"
This cites just one study and completely neglects the countless other studies which have shown Zoloft to be an extremely effective medication for the treatment of depression. It is a first-line SSRI that is often used before any others for treating typical depression, in most psychiatric units. The "Evidence against Effectiveness" section sends a very bad and misleading message. It should be changed or removed completely. --Muugokszhiion 18:59, 22 July 2006 (UTC)
 * To be fair, it seems to me it's a first-line antidepressant because of its relative lack of side effects and probably marketing too. However, I mostly agree: having a separate section for this one study, and none describing studies that support its effectiveness is misleading.  Maybe we could change the section to "Studies of effectiveness" and include more. --Galaxiaad 19:38, 22 July 2006 (UTC)


 * I'm commenting (hiding) the section until more NPOV sources can be added. Since Zoloft (along with the rest of the SSRIs) has been shown to be highly efficacious in the treatment of major depressive disorder, it is important that studies proving its effectiveness be shown as well. Otherwise, the section is very POV. Furthermore, the title should indeed be changed to something more neutral, such as Galaxiaad's suggestion, "Studies of effectiveness." --Muugokszhiion 18:52, 19 September 2006 (UTC)

To be honest, my boyfirend is just on that shit, and as far as I can see... it's only about the people being so sick that they can't be bothered to think about being in a bad mental state. I dunnu if it "works"... I mean if it's proved, but what I know is that making a pretty healthy normal person that just collapsed out of stress into a all-time-sleeping, shaking, throwing up wreck is WIERD... I hope the doctors know what they're doing. Peace.

80 year olds
What's with the line about 80 year olds in the first paragraph? Should it be removed?

Bioavailibility
I noticed that the bioavailibility percentage went from 95% to ~45% just recently. Do we have a source for this change?

Also, I've found several sources claiming that taking sertraline with food increases the bioavailibility (http://psyplexus.com/pt/index.php/2004/10/24/increasing_the_bioavailability_of_sertra), and another that claims taking it with food has no effect (http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=18935).

Medication for childhood experiences?
It seems a lot of research is being done to prove the effectiveness of anti-depressants such as Zoloft. But why, after so many years since the drugs first release to the public, are results still inconclusive? Pfizer’s own Zoloft official web site (www.Zoloft.com) states in every page the risk of increased suicidal rates in children under the age of eighteen is doubled when taking antidepressants. Yet, in another article entitled, “Zoloft Effectiveness in Childhood depression” by Sid Kirchheimer, a study comparing the effects of Zoloft with placebo showed that while 69% of patients taking Zoloft had improved symptoms, 59% of the patients taking placebos also improved their symptoms. Is this a significant enough difference to say that Zoloft is effective? The FDA, based on the data submitted to them by antidepressant drug companies, disagrees. However, “placebo response is very high in short-term studies like this one” comments the researchers Karen Dineen Wagner, MD, PhD, and Clarence Ross Miller Professor and vice chairwoman of psychiatry and behavioral sciences at the University of Texas Medical Branch in Galveston. Their research, funded by Pfizer, was for the duration of only ten weeks. Both agree that further research is needed to make a clear decision in prescribing it to children. In a more recent study by Gregory E. Simon (American Journal of Psychiatry, January 2006; vol 163: pp 1-7.) Suicide rates showed a decline in both adults and children after a six-month period. The risk of suicide rates remained high in the first months of treatment. This study included mostly adults, however. Although child depression is a serious subject, perhaps antidepressants aren’t the solution. Part of being a kid is having the resilience to grow up and overcome certain obstacles that may or may not contribute to depression. If placebo pills can show an improvement in symptoms of children, perhaps doctors shouldn’t “jump the gun” on prescribing antidepressants to them. That is not to say that antidepressants aren’t effective, but that to express extreme caution when dealing with children under the age of 18 until further research has been done to finally put an end to the ongoing debate about the side effect increasing the risk of suicide rates in kids. Perhaps an understanding of the causes of depression in today’s younger generation can provide insightful reasons in determining whether their condition can be helped by antidepressants or if the depression is a normal part of life. Are we creating a need to medicalize normal human experience?

Suicide
This is common amongst all anti-depressant treatments, including ones that are not SSRI-based, and even non-drug treatments ( ie talk therapy ). Many who are depressed describe a lack of "mental energy." These individuals recognize things they could/should be doing to improve their condition, but can't actually carry the task out. ( Excersize is among the best treatments for depression, but (catch 22) you can't get a depressed person to excersize. )

It's a very small logical leap to assume some individuals with major depression symptoms have often contemplated suicide, but, like with excersize, simply do nothing, caught in the depths of their depression. When this type of patient, determined but unable to commit suicide, begins treatment, when their "heavy fog" begins to clear, the worst cases are still suicidal, suddenly find the wherewithall to carry out their long-standing wish.

In fact doctors ( either psychologists or family practicioners ) are alert for early signs of manic happiness in patients who had been morbidly depressed, as this is often an indicator that the patient is considering something rash. FireWeed 23:11, 22 January 2007 (UTC)

Deleting dopamine claims
Disclaimer: I'm not a pharmacologist.

The article currently says:
 * "Sertraline appears also to be a minor dopamine reuptake inhibitor. Dopamine is responsible for the 'feeling rewarded' feeling in the brain (as well as being heavily involved in coordination of voluntary movements). While feeling reward generally leaves the user of the drug feeling great, it is not the intent of the drug."

Which seems to imply that sertraline is directly rewarding/reinforcing. AFAIK, for dopamine reuptake inhibtors to be reinforcing, the effect needs to be fast and strong. Sertraline is neither, as it takes more than 4 hours to reach maximum concentrations and it is much stronger as a SRI than DRI. In any case, a citation would be needed.

The article also says
 * "Interestingly, since activities like smoking cigarettes increases dopamine levels in the brain, some smokers actually have increased cravings while on SSRI drugs."

The relation between these statements is unclear. Is it that dopamine reuptake inhbition increases the effects of smoking? But why does it mention SSRIs in general then (the other SSRIs are not DRIs)? Or is the point that SSRIs indirectly inhibit dopamine and cause cigarette craving? Please clarify.

The section has apparently been tagged since February, so I'm removing those claims and (while I'm at it) turning the section into a "mechanism of action" section. Experts, please improve it :)

84.58.135.53 12:20, 13 May 2007 (UTC)

This sounds like a horrible drug
Maybe someone should list some of the positive effects of Zoloft? --76.185.57.166 20:15, 1 June 2007 (UTC)

Am I the only person that finds the overall tone of the article positive? - Me —Preceding unsigned comment added by 71.224.15.12 (talk) 04:47, 9 January 2008 (UTC)

Practice of anonymous edits should be abandoned!
The Billy Dzomba and Steve Werner hoax has been on the Zoloft Wikipedia page for several months and propagated across thousands of internet pages including answers.com. It is clear that anonymous (IP address) edits are the source of majority of the vandalism and unsourced information. Allowing them may have made sense in the beginning of Wikipedia to attract more editors, but this practice can probably be safety abandoned now. I wonder if there are more people thinking so. Is there any kind of page that discusses this issue in Wikipedia?Paul gene 11:05, 3 July 2007 (UTC)
 * Yes—it's been discussed at length and rejected every time: please see Disabling edits by unregistered users and stricter registration requirement and Anonymous users should not be allowed to edit articles. Fvasconcellos (t·c) 11:49, 3 July 2007 (UTC)
 * I was wrong about Wikipedia having enough editors. Or to be more precise, there are too many editors but not enough contributors.Paul gene 13:08, 25 August 2007 (UTC)


 * I have to disagree with Paul. IMHO, the bottleneck for the improvement of Wikipedia is the adding of new information, not the deleting of vandalism. I think 1 good anonymous contribution more than offsets 100 anonymous vandalisms, which are easily reverted.
 * WP:Reliable Sources guidelines state:" Jimmy Wales has said it is better to have no information at all than to include speculation, and has emphasized the need for sensitivity: I can NOT emphasize this enough. There seems to be a terrible bias among some editors that some sort of random speculative 'I heard it somewhere' pseudo information is to be tagged with a 'needs a cite' tag. Wrong. It should be removed, aggressively, unless it can be sourced." Most of WP editors do not remember that.Paul gene 13:08, 25 August 2007 (UTC)


 * As for hoaxes like the one you mention, that are not obvious vandalism: Disabling anonymous edits won't stop that. If a vandal has the time to think up a believable hoax, he has the time to register. Suboptimal Username 14:08, 18 August 2007 (UTC)
 * Yes, all I want them is to register. Would help to control them - think analogy with prostitution and drugs of abuse.Paul gene 13:08, 25 August 2007 (UTC)

Do sertraline more often than TCAs results in continuation of treatment to the point of achieving therapeutic results?
Hga made a correction to the statement: Sertraline has a similar effect on the core depressive symptoms to the tricyclic antidepressants (TCAs) but because of the lower rate of the side effects sertraline treatment often results in a better quality of life.

After the correction the statement reads: Sertraline has a similar effect on core depressive symptoms as the tricyclic antidepressants (TCAs) but like other SSRIs has more tolerable side effects, which more often results in continuation of treatment to the point of achieving therapeutic results and in a better quality of life.

Hga also commented: "Improvement to addition; I've always read that low side effects before results was the greatest advantage of SSRIs. TCAs are nasty..."

Hga improved the style nicely but I beg to disagree with the meaning of one part: "which more often results in continuation of treatment to the point of achieving therapeutic results". What Hga appears to say is "the drop off because of the side effects of the SSRI therapy is lower than for the TCA therapy". That is not always true: there are nasty SSRIs, for example, paroxetine and nicer TCAs, for example, nortriptyline. So, when sertraline was compared with nortriptyline, the rate of therapy discontinuation because of the side effects was the same. (see Comparison of Sertraline and Nortriptyline in the Treatment of Major Depressive Disorder in Late Life. Am J Psychiatry 157:5, May 2000).Paul gene 22:53, 4 August 2007 (UTC)


 * Ah. I've read what I added (although I'd have to dig up a proper source to support it), and I know from personal experience that imipramine (the previous "gold standard") is nasty ("I have to be truly depressed to put myself on it" :-), that paroxetine can trigger drug induced mania, and that escitalopram (the narrowest in effect SSRI) can be well tolerated.


 * If we compare "gold standard" versions of the drugs, my addition was probably correct. But if we select for lower side effect versions in the respective TCA and SSRI families (as any good practitioner should), I'm quite willing to believe there isn't such a stark difference, or any difference to speak of, as that study indicates.  Although, Tricyclic_antidepressant agrees with my general point, and makes a better one that the TCAs are more toxic in excess and therefore more dangerous if used in a suicide attempt.


 * To properly close this off, we should probably see if we can find a study comparing the side effects of imipramine to nortriptyline, or we could search for one or more of the inevitable review articles that compare the TCA and SSRI families. And then we should amend the various articles like the TCA one to amplify on this point.  Anyone is welcome to "be bold", I don't have time for a while.  Hga 11:13, 5 August 2007 (UTC)

Patent(s)
I believe the patent referred in the History section is only in reference to the US patent. Should this be clarified? 24.226.115.176 19:26, 13 August 2007 (UTC)

Interaction with grapefruit juice
I deleted the study on interaction of grapefruit juice with sertraline because most likely it is invalid. Five elderly people (63-74 y/o) participated. Four of them were taking multiple other medications. In two out of five subjects no changes in sertraline level was observed. The other three got double increase in the through concentration of sertraline. The indications of limited validity of this study: it was small, sick elderly people are not representative of the general depressed population, they were taking other medications making possible that the grapefruit juice increased concentration of the other medication, which in turn increased concentration of sertraline. It is also known that grapefruit juice inhibits CYP3A4 enzyme, while the enzyme responsible for the majority of sertraline metabolism is CYP2B6. CYP3A4 only responsible for ~15% of sertraline metabolism, so it is unclear how its inhibition could increase the sertraline concentration two-fold. Paul gene 01:05, 6 October 2007 (UTC)

GA review
OK - I will add notes here: cheers, Casliber (talk · contribs) 00:28, 18 January 2008 (UTC)


 *  The most active (+)-cis-isomer was taken into further development and eventually became sertraline. - 'become' sounds like it changed into it or something. Another verb or phrase might be clearer. 'was named'? cheers, Casliber (talk · contribs) 00:30, 18 January 2008 (UTC)✅


 * For example, similar improvement of depression scores was in comparative studies  - need a 'seen' after the 'was'? cheers, Casliber (talk · contribs) 00:32, 18 January 2008 (UTC)✅

I passed the article as it easily fulfils criteria and the above two issues are very readily fixed. I found the prose easy but then again I am a psychiatrist so I may have missed some jargonistic expressions or words that others may find issue with.

Now onto FAC: I have this idea that Wikipedia can do information more comprehensively and better than much that we've seen before and I may be a bit ambitious in this but I thnk it is possible here. I'll explain:


 * For true comprehensiveness I think a history of market share since introduction is important. I recall fluoxetine came out, followed by sertraline and paroxetine, with the latter falling away in popularity in Australia anyway. Later on came fluvoxamine, citalopram and finally escitalopram. it wuld be great to expand a little on the competition over the past 15 years.Casliber (talk · contribs) 00:53, 18 January 2008 (UTC)
 * I tried to read on this but the market share of different antidepressants and competition between them vary widely among countries. Unfortunately, there is no lesson to learn from that information. You can read about it here and here  Paul Gene (talk) 02:11, 19 February 2008 (UTC) ✅


 * Also I do recall some issue with some in the field promoting the view that TCAs were superior in melancholia, so addressing this would be good.✅


 * Expanding on the other sections, the use of SSRIs is significant in people with personality disorder and there is some biochemical basis for this. It needn't be very long but the other uses section as is is a bit listy and meagre.Casliber (talk · contribs) 00:53, 18 January 2008 (UTC)
 * One open label study on 11 patients with personality disorders was conducted and I do not think it deserves mentioning. Another large study on depressed patients with co-morbid personality disorders did not have a placebo control, but I mentioned it. There have been no other studies on sertraline for personality disorders, so talking about it more would have given it undue weight. Paul Gene (talk) 01:06, 24 March 2008 (UTC) ✅


 * change 'sertraline patients' to 'patients on sertraline' I think.✅


 * There needs to be a list of various names used in different countries Casliber (talk · contribs) 00:53, 18 January 2008 (UTC)
 * No, WP:MEDMOS discourages the mentions of brand names, except for the one-two the original manufacturer has used. However, I provided the link to Merck manual where many international names are mentioned. Paul Gene (talk) 00:36, 26 February 2008 (UTC)✅


 * there is an issue with many trials of antidepressants in that many exclude people who have suicidal ideation. Unfortuantely this differs markedly from many hospitals where many people have suicidal ideation. As the effectiveness of antidepressants seems to increase with more severe depression this is one of the reasons cited that effect sizes seem small. I've heard this a few times but I am not sure where it has been published as such.Casliber (talk · contribs) 00:53, 18 January 2008 (UTC)
 * It appears that sertraline's efficacy is independent or weakly dependent on the depression severity, in line with results of different meta-analyses of antidepressants. I addressed this issue in several places. No studies has been done on actively suicidal patients, even in the trials on inpatients they were excluded. Paul Gene (talk) 22:12, 23 March 2008 (UTC)✅


 * Fianlly I'd get a lay-person to read it and copyedit before FAC

I'll keep in touch and see how it's developing. Congrats. cheers, Casliber (talk · contribs) 00:53, 18 January 2008 (UTC)

other uses
why doesnt it say anything about doctors using it with kids with adhd and asd?-- The Last Uchiha  10:00, 7 February 2008 (UTC)

Its used for IBS too. Many antidepressants nowadays are used for conditions other than depression. They are used in a wide array of physical conditions too but somehow the article lacks the information — Preceding unsigned comment added by 98.169.167.183 (talk) 09:39, 16 July 2012 (UTC)

Skeletal structure problem
On the skeletal structure and the ball-and-stick model of the molecule, there are two chlorine atoms, but in the info table, the formula is C17H17N (no chlorine present). Which one is correct? —Preceding unsigned comment added by 72.175.41.175 (talk) 03:24, 25 March 2008 (UTC)
 * The structures are correct. The chlorine atoms must have been removed from the drugbox; the molecular weight still matched C17H17Cl2N. I've added them back, thanks for noticing. Fvasconcellos (t·c) 16:47, 25 March 2008 (UTC)

Preparing for FAC
OK then, I am reading a book by David Healy which may be very useful in providing some reliable sources for the background and criticisms. The main thing as the article should not merely resemble a product information page. Cheers, Casliber (talk · contribs) 00:25, 20 April 2008 (UTC)

OK, before copyediting we need to make sure nothing notable has been left out and everything is referenced - every paragraph should have at least one reference:


 * Para 1 of History needs some refs at the bottom of it. Also nthing about the development of it before approval but I may be able to help out there.

Gotta go now. more later. Cheers, Casliber (talk · contribs) 00:25, 20 April 2008 (UTC)


 * On second thoughts looking better than I thought. We aren't too far away. I can't do much until tonigh though (Sydney time). Cheers, Casliber (talk · contribs) 00:34, 20 April 2008 (UTC)


 * I moved the relevant references from the beginning to the end of the first paragraph of the History. This paragraph talks about the development before the approval. I hope I researched and referenced the article exhaustively; I am rather afraid that there will be complaints that it is too detailed, and there are too many references. Paul Gene (talk) 00:48, 20 April 2008 (UTC)


 * Don't worry, I am getting familiar with the process now after 16 FAs. It isn't too detailed and this book may provide some more social context. Copyediting will trim a bit too. Cheers, Casliber (talk · contribs) 01:01, 20 April 2008 (UTC)


 * Which Healy book are you referring to? I have most of them. He usually talks about SSRIs/antidepressants in general, so this may not be applicable to specifically sertraline. He is also sometimes wrong. As far as I remember, the only particular antidepressant he discussed at length is fluoxetine, but then it could be that I am missing something, since I read some of those books more than a couple years ago. Paul Gene (talk) 10:16, 20 April 2008 (UTC)
 * You're right, it is The Antidepressant Era and only mentions it twice, though does give UK release date which will help this article to be less US-centric..Cheers, Casliber (talk · contribs) 05:11, 21 April 2008 (UTC)


 * In the first bit of the Indications section, is it worth pointing out these are worldwide? Cheers, Casliber (talk · contribs) 09:10, 20 April 2008 (UTC)
 * I do not know, I used the FDA-approved indications. Paul Gene (talk) 10:17, 20 April 2008 (UTC)

Readability
Given that you and I may lapse into jargon without realising it, it would be good to get a layperson to have a look. I will try and find someone. Cheers, Casliber (talk · contribs) 05:17, 21 April 2008 (UTC)


 * Oops. first try didn't work so well...Cheers, Casliber (talk · contribs) 14:35, 22 April 2008 (UTC)


 * I asked Galaxiaad, who is a pharmacist, and FVasconcellos, who is not an MD or pharmacy professional (my guess, which could be wrong), to look at the article. They did a lot of copyediting but did not seem to find any major problems. I intentionally divided the article into many sub-chapters so that the lay reader could jump to the part he is interested in. Paul Gene (talk) 00:14, 24 April 2008 (UTC)


 * Oops, I'm just a pharmacy tech. ;) So I do have pharmacy experience but haven't gotten farther than gen chem and bio in school so far.  I only got partway through the article so I'll try and finish my copyediting tonight.  I also had a couple places that are unclear to me, which I was going to ask about on here... sorry I've taken so long! --Galaxiaad (talk) 03:22, 24 April 2008 (UTC)


 * Will finish up tomorrow. --Galaxiaad (talk) 06:11, 24 April 2008 (UTC)

Questions
These aren't necessarily things I think should be changed. They're just things that weren't totally clear to me.

''The original pre-marketing clinical trials demonstrated only moderate efficacy of sertraline for depression. Nevertheless, later research firmly established sertraline as one of the drugs of choice for the treatment of depression in outpatients.''

Does this mean later trials showed it was more effective than earlier ones suggested? Or just that the SSRIs have less side effects than the TCAs and so superseded them?

Are there any meta-analyses or big trials of just efficacy vs. placebo? All I really see is "more effective than placebo" and "equally effective as TCAs and better tolerated". But how much more effective than placebo? What's "moderate efficacy"? What I guess I mean is it'd be helpful to the lay reader to see what percent of depressed patients respond (as compared to placebo). But I do see the problem in coming up with one number for this.

''Patients on sertraline also reported significantly better social and physical functioning. The patients who achieved a remission during the trial (30% of the sample) did not differ from the healthy population on the measures of marital, parental, physical and work functioning and were close to normal on social adjustment and other measures of interpersonal functioning.''

I can't find the full-text article to check--does the 2nd sentence refer to only the sertraline patients, and only after treatment?

At the same time, sexual desire and overall satisfaction with sex stayed the same, as in the beginning of the sertraline treatment, and slightly below the placebo.

Can't see the full text on this one either. Does this mean desire and satisfaction stayed the same as they were before treatment in the sertraline group, and increased slightly in the placebo group?

In addition to decreasing the frequency of panic attacks by about 80% and decreasing general anxiety, sertraline resulted in improvement of quality of life on most parameters, in contrast with the placebo, which did not improve the quality of life as much even among the patients who apparently responded to it.

I'm just having trouble with the phrasing here: "improvement of quality of life on most parameters, in contrast with the placebo" makes it sound like it didn't improve with placebo, but it did, just not *as much*. I can't think of a better way to phrase it.

That's it. I'm really impressed by this and all the work you've done, Paul Gene. --Galaxiaad (talk) 07:36, 25 April 2008 (UTC)


 * The original pre-marketing clinical trials... I added reference to a meta-analysis of pre-marketing clinical trials and corrected the wording to weak-to-moderate. Weak is effect size 0.2, moderate - 0.5. Sertraline has 0.26 according to the quoted paper. Percent-wise difference is hard to pinpoint because of the different size of placebo effect and the measures used (response, remission, improvement, significant improvement). The problem with the double-blind design is that even the patients on the active medication do not know what they are taking. In the actual practice, the patient always knows that he is getting active medication, so it adds additional non-specific (placebo) effect. For example, if all of the patients in a certain practice are just assigned to sertraline, thus avoiding prescription bias but not blinding them, sertraline shows stellar results (with more than 70% of the patients improved). Then again, that trial was financed by Pfizer. The effect size in the later double-blind trials is almost certainly higher, which could be due to the both Pfizer learning to ask the right questions and select the right patients and the publication bias.

Sertraline superseded TCAs mostly because of the fewer side effects. It is used more than other SSRI's in the US probably due to the Pfizer marketing might. There are no objective differences between sertraline and escitalopram. Sertraline may be more effective than fluoxetine in some patients, and it certainly has milder withdrawal syndrome and cognitive side effects than paroxetine. Do you think that should be mentioned in the lead, or the corresponding comparison part reworked completely? I would appreciate your help. Paul Gene (talk) 11:11, 25 April 2008 (UTC)


 * Thanks for the responses. I'm definitely in the dark about most of the clinical-trial stuff (now not quite so much!)  But I like the new lead.  I think it'd be good if others weighed in (on the new changes, I mean)... but I guess that'll happen at FAC anyway. :) --Galaxiaad (talk) 05:34, 26 April 2008 (UTC)

Lead
The article looks really good (although pls ask User:Brighterorange to run through and fix the dashes, and please check for remaining unlinked dates in the citations). But, the lead doesn't seem to be an adequate summary of the article (see WP:LEAD). It scarcely touches upon Indications, most of Adverse effects, and Controversy. The lead should hit all highpoints, all significant controversies, and provide a stand-alone summary of the entire article; it's not doing that. As a layperson, I already know a lot more about zoloft than the lead is telling me. Sandy Georgia (Talk) 03:54, 27 April 2008 (UTC)
 * Added more material to the lead, and thank you, Galaxiaad for fixing the redundant refs, dates and dashes. Paul Gene (talk) 11:13, 27 April 2008 (UTC)


 * Also, you might want to work this in to the pediatric OCD info:   Also, the article doesn't seem to deal with trichotillomania.  I don't know that much about it, but I found this:    I'm not sure that's worthy of inclusion, but the info on treatment of OCD with comorbid tics or Tourette syndrome does need to be mentioned, as zoloft treatment is common.  Also, my (British journal) sources list an additional name:  Gladem.  That's from Robertson MM. "Tourette syndrome, associated conditions and the complexities of treatment" (PDF).  Brain. 2000;123 Pt 3:425–62.  Sandy Georgia  (Talk) 04:13, 27 April 2008 (UTC)


 * is a poor quality paper. The liberal use of statistics (Quote: "The post-treatment CY-BOCS score mean (SD) for patients without a tic disorder was slightly lower with (15.5 (5.3)) than without (17.0 (5.6)) a tic disorder, but the main effect of tic disorder was not statistically significant (Wald X2 = 1.21, p < .05) where the tic disorder treatment interaction term was statistically significant (X2 = 12.32, p < .006).") obscures a simple fact that the authors studied a small sub-group of 15 children from a larger trial. They compared them on several factors, and even though one of them appeared to reach statistical significance, this result by no means can be considered reliable. Paul Gene (talk) 11:28, 27 April 2008 (UTC)
 * is another bungled study. 40% (16 out of 42) subjects including all but two (!) placebo patients dropped out. Most of the changes were not statistically significant. Paul Gene (talk) 11:47, 27 April 2008 (UTC)
 * Gladem. The lists of international brand names is an unnecessary trivia. But at the end of the article I provided a link to the reliable list of international names for sertraline from The Merck Manual. Paul Gene (talk) 11:58, 27 April 2008 (UTC)
 * Tourette. Added.

Citations in the Lead Copying from a discussion on my Talk page : There is no exception to citation requirements for the lead. Leads are often pretty general, so sometimes it's not practical to cite a general statement which is broken down and cited more specifically later in the article. A statement like the one in question is very specific, and there is no reason to exempt from the obvious need for a citation. A few additional comments.
 * The statement is very specific, which is why it should be cited, and perhaps also why it doesn't really need to be in the lead. The lead is for a general overview of the topic, not descriptions of which treatments surpass others in what combination. The claim seems to have just two sources, which doesn't merit being stated as fact. Is it a majority view in the field that CBT is superior?
 * Good article! Congratulations to the editors. I've said my 2 cents on this very minor point, so I won't make the edit again. Life.temp (talk) 02:59, 7 June 2008 (UTC)

suicidality
can we change the word for suicide (ie: rate of suicide) ? I am not sure that the word (suicidality) exists in english, and if does, it should not... —Preceding unsigned comment added by 65.4.91.165 (talk) 02:03, 6 June 2008 (UTC)


 * It exists in the medical jargon, but it's nearly unknown outside of it. I agree that a term like "suicide rate" (if this is indeed what's meant?) would be clearer to more people. --Delirium (talk) 02:47, 6 June 2008 (UTC)


 * Suicidality and suicide rates are not (necessarily) the same. While suicidality encompasses a broader spectrum of suicide-related issues, such as suicidal ideations, tentaminis suicidii, suicidal crisis, parasuicides and completed suicides, suicide rates are only quantifications of some of these phenomena (mostly tentamini and completed suicides) in groups of people/patients studied.--84.163.108.240 (talk) 02:57, 6 June 2008 (UTC)
 * The word was coined by the FDA to describe the total of the above phenomena. It is a legitimate word and it with time it will make it to the official dictionaries. Albeit it may sound awkward, the general reader should have no problems understanding it — suicide+ity. Paul Gene (talk) 09:24, 6 June 2008 (UTC)


 * I'm a little bit more than a general reader -- I've read about this issue of suicides in Science and NEJM -- and I have problems understanding it. (I think it's a composite of suicides, suicide attempts, and suicidal ideation). It's not a word a general reader could understand. If it's not in the dictionary, it's a neologism or jargon term, which violates WP:WTA. If you use it in the entry, you have to define it first.


 * The important point (in my understanding) is that there is no high-quality evidence that any of the antidepressants cause suicide, because of the low power, low numbers, and short duration of antidepressant studies, so they use suicidality as a surrogate end point. But, as the NEJM always says, surrogate endpoints are often wrong (like the surrogate end point of blood loss instead of mortality in the aprotnin study, 358:2398). So while there is evidence for "suicidality", which may or may not turn out to be an artifact, there's no high-quality evidence for increased suicides, and SSRIs may or may not cause increased suicides. Nobody knows at the usual standards of scientific certainty. I think the entry should make it clear.


 * BTW the Cochrane Collaboration doesn't use the term "suicidality" at all, they say "suicidal ideation and attempts", which is what I think we should use. They say:


 * There is evidence that those prescribed SSRIs are at an increased risk of suicidal ideation and attempts (RR 1.80, 95% CI 1.19 to 2.72) consistent with a number of similar reviews in the area. Additionally, there was an increased risk of other adverse events. It is unclear how this relates to the risk of suicide completion. The trials were not designed to measure any of the suicide related outcomes adequately. At the same time, untreated depression is associated with the risk of completed suicide and impacts on academic and social functioning, however, it is not clear whether treatment with an SSRI will modify this risk in a clinically meaningful way for children and young people.


 * I think you should read the whole Cochrane entry for a good discussion of the issues. Nbauman (talk) 01:59, 9 June 2008 (UTC)

Synthesis
Is it Ok to include the synthesis of the compound into the article? The sythesis is interestin and includes a enantioselective step at the end in which only the desired enatiomere is formed. Normaly the pharmacetical industry starts with compounds from the chiral pool to do this.--Stone (talk) 06:31, 6 June 2008 (UTC)


 * This issue was discussed during the FA nomination. I believe that synthesis of sertraline is of little interest even for specialists, and of no interest whatsoever to the general reader. Paul Gene (talk) 09:20, 6 June 2008 (UTC)

agree - synthesis is of interest only to specialist.HOWEVER, the point that sertraline is chiral (one enantiomer) could be of interest re side effects (eg the side effects of thalidomide are due to one enantiomer, the other is actually useful for something). However, untill there is some clinical evidence on this point, it can be left outCinnamon colbert (talk) 12:57, 6 June 2008 (UTC)
 * 1. It's one diastereomer (enantiomer pair) of sertraline isomers, 2. thalidomide enantiomers are undergoing racemization in vivo each, so that after all, racemate and both enantiomers are teratogenic (it is used as an adjunctive antileprotic, given that effective contraception is provided during the treatment).--84.163.108.240 (talk) 13:03, 6 June 2008 (UTC)

I am not sure wether this answer is meant to be misleading or not, but there is not mention of synthesis in the FAC. Anyways I find your statement " synthesis of sertraline is of little interest even for specialists" to be at least apalling. I am not sure how much you have interacted with true specialists, but your view on this topic is really limited. I am not going to spend minutes arguing how Sertraline is first of all a chemical and then a drug. Even if it were, the article should have at least a link to a sub-article presenting synthesis reported in academic literature and if available, the comerical one too. Nergaal (talk) 10:24, 6 June 2008 (UTC)


 * Where exactly in the FAC was this stated?--Stone (talk) 21:13, 6 June 2008 (UTC)


 * The sythesis might be as interesting as Pharmacokinetics for most of the people! So the synthesis should be a small section mentioning the first synthesis and the now used synthesis which is considerable more easy. --Stone (talk) 21:13, 6 June 2008 (UTC)
 * There is a reference to the first synthesis of sertraline in the article—it is the review of sertraline development by Welch. The journal = Chirality synthesis does not look that much easier to me. Paul Gene (talk) 09:28, 7 June 2008 (UTC)

Image
I happened to have a 3D tubes image of sertralines' structure, which I've uploaded and made public domain (it was my own work). This article already has a perfectly good 3D balls image, so I didn't add my image to the article, but I thought I'd mention something here so people knew the image existed if it was needed anywhere.



Hopefully this is actually useful to someone. If not, ah well. CrazyChemGuy (talk · contribs) 02:30, 11 June 2008 (UTC)

This is getting a bit silly
It's not that good, I see more success with other medications, but some of this article is giving the reader the opinion that it's the best thing there is

I know it has helped some people, but this drug is clearly over-rated --Steve (talk) 05:35, 2 May 2009 (UTC)

No, this is getting a bit silly
A week of low-level revert warring over a paragraph on discontinuation. Nice. Fvasconcellos (t·c) 00:09, 7 May 2009 (UTC)

High-dose sertraline for OCD
There has been some back and forth reverting over a summary of this article: http://www.ncbi.nlm.nih.gov/pubmed/16426083. I can only see the abstract, but it clearly says that the high-dose group had significantly greater symptom improvement. However, it says that responder rates were not significantly different. If someone can look at the article maybe we can see the reason for the discrepancy, and improve our summary. --Galaxiaad (talk) 15:55, 26 July 2009 (UTC)


 * Yes. I'm sure someone can improve this part with a neutral perspective. Also it should be noted that the editor The Sceptical Chymist likes to undo without any reason. When you look at history, you see he has been doing -undo without reason- for a long time. camoka4 (talk) 18:48, 26 July 2009 (UTC)


 * Very well. The paper states: "There were no significant differences between treatment groups on response rates. 33% percent of patients (12/36) receiving 200 mg/day and 40% of those receiving the high dose [250-400 mg] (12/30) met responder criteria by treatment endpoint (χ2 = 0.31, df = 1, p = .58)."


 * From Table 1. "Efficacy Measures Across 12 Weeks of Sertraline Treatment Among Patients With Obsessive-Compulsive Disorder"


 * YBOCS baseline. 200 mg group = 25.1 (SD 4.1). 250-400 mg group = 26.2 (SD 3.8)
 * YBOCS after 12 weeks. 200 mg group = 21.8 (SD 7.2). 250-400 mg group = 19.2 (SD 6.4)


 * CGI-I baseline. 200 mg group = 3.5 (SD 0.6). 250-400 mg group = 3.7 (SD 0.7)
 * CGI-I after 12 weeks. 200 mg group = 3.1 (SD 0.8). 250-400 mg group = 2.8 (SD 1.0)

The Sceptical Chymist (talk) 20:04, 26 July 2009 (UTC)


 * Cool. I think we should qoute this study. It's more clear and easier for people to understand.


 * MJ Byerly, WK Goodman, and R Christensen
 * Am J Psychiatry 153:1232-1233, September 1996
 * ........During weeks 20 and 21 of sertraline administration, the dose was increased to 250 and then to 300 mg/day without appreciable side effects. After 5 weeks of treatment with sertraline, 300 mg/day, Mr. A reported a “ dramatic” improvement in obsessive symptoms. There was a 44% decrease in the total score on the Yale-Brown Obsessive Cornpulsive Scale (from 27 to 15). Time occupied by obsessive thoughts had decreased by 87.5% (from 16 to 2 hours/day). Over the next 6 months, he experienced continued improvement in obsessive-compulsive symptoms, including a 50% decrease in time occupied by compulsions (from 3 to 1.5 hours/day)...........
 * http://ajp.psychiatryonline.org/cgi/reprint/153/9/1232b
 * http://www.ncbi.nlm.nih.gov/pubmed/8780435
 * --camoka4 (talk) 21:09, 26 July 2009 (UTC)


 * To The Sceptical Chymist: Yes, as I said, it's stated in the abstract that response rates (i.e. percent of people in each group meeting the responder criteria) were not significantly different, but that (presumably mean) improvement in symptoms WAS significantly better in the high-dose group. It's a complicated situation, and that's why I think we should explain it more in our article.
 * As for the study you present, camoka4, I don't think it's appropriate to use a case study where we have a larger, better controlled study. Maybe we could include both.  Any other editors want to comment?
 * --Galaxiaad (talk) 23:41, 26 July 2009 (UTC)


 * Galaxiaad, you're right. I want to point out another issue. From the article summaries, it's not clear what is meant by 'high dose'. 200mg/day is the recommended max dose according to the manufacturer, so it could be considered as a high-dose by the reader, whereas 200mg/day is considered as the 'lower dose' in both of the studies. Any editors want to comment on this?


 * --camoka4 (talk) 09:50, 27 July 2009 (UTC)


 * RE: Galaxiaad. I would suggest the following explanation. After the authors of study did not find significant difference on the primary outcomes: YBOCS and CGI-I, they needed to justify the time spent and expense of their study. (The study was financed by Pfizer, manufacturer of Zoloft, and two of the authors were Pfizer employees). So they engaged in a bit of statistical wizardry.


 * It is generally accepted that post-hoc, and in particular sub-group and components of the score analyses, are unreliable. If you run enough comparisons, eventually some of them will come up significant. In the full text, the authors conducted "random regression analyses", which "revealed significant differences in rate of change [bold mine TSC] ... between the 2 treatment groups on the YBOCS, NIMH Global OC Scale, and CGI-I." Simply put, the difference in the symptoms was not significant while the difference in the curve slope was. In their summary, authors renamed the "rate of change" into "symptom improvement" further confusing the issue. The reason why they did that? - probably financial considerations. The Sceptical Chymist (talk) 10:58, 27 July 2009 (UTC)


 * RE: Camoka 4. I changed the wording to reflect your concerns that it was not clear that the lower dose was actually the highest recommended. I also changed the wording to be closer to the authors' conclusion. The Sceptical Chymist (talk) 10:58, 27 July 2009 (UTC)


 * to The Sceptical Chymist: Thank you for the summary.
 * to all editors: I have found another study where it says the greatest improvement in OCD symptoms have been reported on 200mg/day Zoloft, respectively higher than the recommended dose for panic disorder and depression patients. Do you think it should be included too? If yes, how can we improve the link of the source?
 * http://books.google.com/books?id=X5kc2WYyXfIC&pg=PA306&lpg=PA306 :::::::--camoka4 (talk) 12:28, 27 July 2009 (UTC)


 * The Sceptical Chymist: Thanks, that makes sense to me. I don't claim to be an expert on any of this, especially the statistics.  I do think this is much better than reverting back and forth with no discussion.
 * camoka4: I believe the sertraline study cited in that book is here: http://www.ncbi.nlm.nih.gov/pubmed/7702445. Our article already links to that study.  I'm not sure if it is appropriate to conclude from it that 200 mg is more effective for OCD than lower doses (as the author of that book did)... what do you think, Sceptical Chymist?  Again I'm not looking at the full text, sorry... I might be able to do it through my school and may try later...
 * --Galaxiaad (talk) 18:32, 27 July 2009 (UTC)


 * I added the following to the article based on open-access references. How does that look to you? --- "Although the evidence base is modest, it is generally accepted that for OCD, unlike depression, the higher dose of the SSRI results in a better response.[65] The onset of action is also slower for OCD than for depression. The treatment recommendation is to start treatment with a half of maximal recommended dose for at least two months. After that, the dose can be raised to the maximal recommended in the cases of unsatisfactory response.[66]" The Sceptical Chymist (talk) 11:35, 28 July 2009 (UTC)
 * Sceptical Chymist: I think your summary looks great. I made some recent changes: It is generally accepted already means that the evidence is modest, so I dropped out the first part, I think it looks better no? I changed SSRI to sertraline because not all SSRI respond the same way. this unlike depression could give you the idea high doses dont work for depression, and confuse the reader even further, so I made some little change there......anyway, what do you think about the latest version?
 * camoka4 (talk) 21:23, 28 July 2009 (UTC)


 * I wrote exactly what the references said. Higher dose of an SSRI for depression does not result in a better response. The evidence that higher dose of sertraline leads to a better response in OCD is tenuous. However, if one looks over the whole group of SSRIs, one can find some supporting evidence for this hypothesis. That is why you cannot change "SSRI" to "sertraline". The Sceptical Chymist (talk) 09:01, 29 July 2009 (UTC) On the other hand, what I wrote was too complicated for a general reader, so I have to agree with your version. The Sceptical Chymist (talk) 09:15, 29 July 2009 (UTC)


 * Studies have shown positive dose-response relationship for fluoxetine,[33] paroxetine[34] and sertraline[35] but not for clomipramine, fluvoxamine and citalopram. http://www.medscape.com/viewarticle/559370_6
 * If you dont have any other objections, I am in favour of leaving this section without any further edit. camoka4 (talk) 15:42, 29 July 2009 (UTC)

Unjustified edits to the stable version
Attempted revisions of the stable version are unjustified. To say "mild" inhibitor is incorrect. Other revisions made the article worse. The stable version proceeds logically: it begins with main action (SRI) and illustrates that by in vivo human SRI experiments. The less important actions are mentioned later. The attempted revision mixes everything up. The Sceptical Chymist (talk) 02:27, 14 December 2009 (UTC)


 * I have to agree that the version Sceptical has reverted to appears more logical for the reasons outlined above. Casliber (talk · contribs) 03:29, 14 December 2009 (UTC)

This is preposterous. Please bring it to the Talk page—low-level revert warring is incredibly damaging, especially in a Featured article. Fvasconcellos (t·c) 11:47, 24 December 2009 (UTC)


 * I have been requested by FV to comment on this editing dispute. I think The Sceptical Chymist's edits are much more preferable. I see text being moved around making it look like it is uncited by Editor182. I have noticed disruptive editing by Editor182 on other articles, such as "randomly" adding lots of citation tags to cited text and doing text edits which worsen articles over a wide range of psychopharmaceutical articles. Further he keeps blanking his talk page aggressively when anyone contacts him about his disruptive edits. This problem is not unique to this article but is a pattern of Editor182. He may need to be blocked from editing the encyclopedia in my view.-- Literature geek |  T@1k?  19:24, 26 December 2009 (UTC)

My edits are a contribution, if I'm to be blocked for whatever reason, it's no skin off my nose. I've improved a wide range of psycho-pharmaceutical articles, not "worsened" - define "worsened" please? I've also added numerous images to articles, including that of sertraline. The Sceptical Chymist has a long history of edit warring, which came as no surprise to me after the fact. He also aggressively reverted my entire edit, which included an image and a number of other minor edits. In your message, you stated that I wasn't giving enough details when performing edits, and marking them as minor, though that may be true, and I have since changed that, it doesn't mean I've "worsened" an article in any way whatsoever. If I wish to clear my user talk page after I read messages and have nothing more to say, that is my prerogative. Furthermore, the sertraline section which was in dispute is improved under my revision. The old revision wasn’t summarized and poorly put together. Because serotonin and dopamine are two of three primary neurotransmitters, even if dopamine and norepinephrine are catecholamines, whereas serotonin is an indoleamine, it doesn't make it illogical to point out the mild dopamine reuptake inhibition right after serotonin and before proceeding onto other less prominent neurochemicals. Editor182 (talk) 10:14, 4 January 2010 (UTC)


 * Beyond WP:Personal attacks above and vandalism of my user page, Editor182 did not offer any explanations for his edits. I would like to make several additional points in favor of the stable version before Editor182 edits.
 * The stable version of this article passed through the scrutiny of WP:FA process. Editor 182 fails to demonstrate the need to change it.
 * Saying "mild dopamine uptake inhibitor" (as in Editor182 version) is incorrect and borders on OR since mild offers positive connotations unwarranted by any data. It would be better to say weak or only characterize the dopamine uptake inhibition numerically, as the stable version of the article did.
 * The stable version proceeded in a logical order to first discuss serotonin uptake inhibition, the main mechanism of sertraline. Editor182 changed that and interrupted the logical flow by dividing the serotonin uptake part with less important information about weak actions of sertraline on adrenaline, sigma and DA systems. In addition, Editor182 created several one-sentence long, stubby paragraphs.
 * The article already has the picture of Zoloft 25-mg and 50-mg tablets from the US. Does it need an additional picture of Zoloft 100-mg tablets from Australia, which Editor182 added? The Sceptical Chymist (ttalk) 12:03, 5 January 2010 (UTC)

Replacing "mild" with "weak" isn't something that I'm going to go up against. The article already had a picture of 25 and 50 mg tablets, yes, well now it has a picture of the 100 mg tablets too. Editor182 (talk) 19:11, 6 January 2010 (UTC)

Perhaps my words were a bit harsh Editor182 and if so I apologise. I acknowledge that you do make constructive contributions but you have in the past added multiple fact tags to articles for cited text, which is cited to abstracts which do not take long to read. The other problem is any time anyone tries to give you warnings or contact you on your talk page you immediately delete the message. This can be quite antagonistic and is not collaborative. Then on this article you resorted to edit warring, although admitedly so did Sceptical Chymist. None of us are perfect but perhaps you could interact with wikipedians and stop blanking any comments from your talk page, like leave them up for a week or so before clearing them. No one can force you and it is your choice.-- Literature geek |  T@1k?  23:04, 13 January 2010 (UTC)

I reinstated the Zoloft 100 mg image. Zoloft is available in three doses, all of which are now exemplifying. Removing the image because the tablets are from Australia is erroneous. Please remember that Wikipedia articles are supposed to represent a worldwide view on topics. I'm not going to dispute the reversion of Pharmacodynamics. Editor182 (talk) 09:35, 19 January 2010 (UTC)


 * I see no problem with the addition of the image. Thank you for adding it.-- Literature geek |  T@1k?  00:08, 21 January 2010 (UTC)

Poor quality image of 100 mg tablets
Editor182 insists on keeping this poor quality image, which is frankly a detriment to a FA. It is over exposed, out of focus and done with a flash. Moreover, he wishes to remove photos which are not branded Zoloft - however, the article is on the compound sertraline and NOT the brand Zoloft. Please arrive at a consensus regarding removal of the 100 mg photo. --Kristoferb (talk) 19:30, 26 June 2010 (UTC)

There is no need to display the images in question on the discussion page.

I have brought this issue to the attention of administration. This is an English version of Wikipedia. The image of the Turkish sertraline 50 mg capsules is not a contribution, the image is not in English, there are other non-English versions of Wikipedia which you're welcome to use. This article already has images of all 3 available dosages. If two people disagree over an edit and a third established user is also undoing your edits, not only on sertraline, but paracetamol as well, where you're also warring over this same issue, then you need to stop persisting. Your image is not suitable for these articles and at this stage an article ban is required. Editor182 (talk) 01:28, 27 June 2010 (UTC)


 * Wikipedia has a mandate to show a worldwide view. The fact that a generic is made in Turkey has no relevance. It shows BOTH a generic version and a capsule form. The article is NOT on a brand but a chemical compound. There is thus no superiority to showing a brand. Eliminating the generic detracts from the value of the article. You simply take offence to having a superior image replace your poor ones. Editing and updating is at the heart of Wikipedia. We need to see the image in order to judge it. --Kristoferb (talk) 02:25, 27 June 2010 (UTC)


 * If you would look above, you would see that a strongly support a worldwide view. What you fail to understand is this is an English version of Wikipedia, your images are not in English. They are many different Wikipedia's in different languages, which are not translated pages. The images you keep forcing into these articles don't belong here. Furthermore, there are other quality images available. It is not suitable, and another user has agreed, that is enough reason to stop your lunacy. There's nothing more for me and you to discuss on this page, you're like talking to a brick wall, nothing sinks in. I am in communication with others to hopefully get this matter resolved promptly. I do not know why you are even bringing up the Zoloft 100 mg image, which is not in question. If you would look above, you would see that another appreciated the addition of the image. You're completely blindsighted to what everybody else has to say. Editor182 (talk) 02:47, 27 June 2010 (UTC)
 *  Images are not in English or any other language - they are pictures! You images are poor quality - you simply take bad pictures. I am sorry, but it is a fact. All you have to do is look. Indeed, you don't even have to speak English to know your photos are poor quality. I am fully within my rights to edit - that is the nature of Wiki. You clearly do not understand the issues here. --Kristoferb (talk) 02:53, 27 June 2010 (UTC)


 * It isn't about images, it's about the quality of the article and that it can do without your image. I contribute far more than just images to articles, but I've seen nothing else from you except replacing brand name images with illegitimate or generic versions on several articles, that alone shows your interest is in nothing else but yourself, on top of the fact you refuse to accept the decision of other users. We'll await the consensus from administration, as you don't seem to care what anybody else thinks. Editor182 (talk) 03:06, 27 June 2010 (UTC)
 * The article is about the generic and not the brand name. Is the title of the article "Zoloft"? No. The article is on the compound sertraline. I don't want to be rude, but can you honestly not understand my photo is of sertraline because in Turkish there is no "e" (i.e.: sertralin)? Moreover, it seems in your reading you did not discover that India has different laws than elsewhere and generic Propecia is perfectly legal. Get your facts straight before going on the attack. --Kristoferb (talk) 03:14, 27 June 2010 (UTC)
 * I don't see the illustration as a problem in general. It's the only one (at present) that actually shows the capsules. And that's where a problem could arise - capsules aren't sold in the USA anymore. That part could mislead the readers. ←Baseball Bugs What's up, Doc? carrots→ 03:09, 27 June 2010 (UTC)
 * " The aim is to provide a worldwide view, not an American view. --Kristoferb (talk) 03:14, 27 June 2010 (UTC)


 * That's also true, it is both misleading and doesn't contribute to the article at all. It has nothing to do with the worldwide view, you're refusing to accept anybody else's opinion. NuclearWarfare (talk) agrees with removing both this and the second image in dispute, which is in paracetamol, but Kristoferb (talk) is under the delusion that the user is a "puppet". I don't think anybodies opinion is going to get through to this person. Editor182 (talk) 03:19, 27 June 2010 (UTC)
 * I don't think NuclearWarfare (talk) considered the issue fully. That is what we are doing now and here. How does it not contribute to the article? What is the name of the drug in my photo? And what is the name of the article? Please, do explain. --Kristoferb (talk) 03:22, 27 June 2010 (UTC)


 * I've explained it over and over. Another user reverted both your images. Another user just gave their input. Are all three of us not considering the issue fully? Even if 10 users were reverting your edits, it wouldn't be enough. What you need is a ban. Enough explaining. Editor182 (talk) 03:28, 27 June 2010 (UTC)
 * Your "explanation" is a load of nonsense. That is the real problem. Brand better than generic: nonsense. Not in English: nonsense. ←Baseball Bugs What's up, Doc? carrots→ agrees with me and thinks the image should stay! Try to follow! --Kristoferb (talk) 03:31, 27 June 2010 (UTC)


 * Are you also reading what you want to see now? Baseball Bugs just said that your image could be a problem and misleading. What part of that sounds like "the image should stay!"? This is why it's useless trying to communicate with you. Editor182 (talk) 03:46, 27 June 2010 (UTC)
 * To quote: "I don't see the illustration as a problem in general. It's the only one (at present) that actually shows the capsules". Not a problem in general means he agrees with me. Since you are so obsessed with things being in English, I had hoped you were able to understand it.--Kristoferb (talk) 03:52, 27 June 2010 (UTC)


 * Oh, I understand now, you don't read what you want to see, you only read what you want to. How about the rest of what was said? "And that's where a problem could arise - capsules aren't sold in the USA anymore. That part could mislead the readers." Why can't you accept that two established users reverted your edits and end it at that? Who are you to say we aren't considering the issue fully? You're stubborn and relentless. Editor182 (talk) 04:06, 27 June 2010 (UTC)
 * The best thing would be if someone could post a photo that shows some of the pills, with the wording on the box in English. ←Baseball Bugs What's up, Doc? carrots→ 04:18, 27 June 2010 (UTC)


 * If Kristoferb or anyone else can produce that image, it would be fine. In the meantime however, if someone else could revert the edit, it would at least show that several users disagree with this edit in the featured article, although NuclearWarfare (talk) already reverted his edit in sertraline (and paracetamol), two people opposed is evidently not enough to get the message through to this person. Editor182 (talk) 05:16, 27 June 2010 (UTC)


 * The one with the bottles and pills clearly visible (as opposed to sitting on foil, and I only just now spotted them) would seem to be the best image at present. In fact, you really only need one image - unless you're trying to make the point that the pills come in different forms in different countries: then the foreign-language photo might serve a purpose. ←Baseball Bugs What's up, Doc? carrots→ 05:52, 27 June 2010 (UTC)


 * Nobody has had a problem with the Zoloft 100 mg image, which is discussed separately above, though I think its been brought up to distract the real issue, as has been the case in paracetamol. Initially Kristoferb came in with his image and replaced the Zoloft 100 mg image. Likewise, in the article on finasteride, he replaced the brand name Propecia image with an illegitimate generic from India, as the drug is still patented. This alone shows callous.

It is quite easy for me to justify the Zoloft 100 mg image on this article:


 * It is the current Zoloft 100 mg from Australia (same UK design), so nothing is misleading.
 * Zoloft comes in 3 doses, but only the 25 mg and 50 mg tablets are shown in the photo from the US.
 * It could be misleading for Australians or those from the UK who get their tablets in boxes, not bottles.
 * The image shows great detail of the boxes writing and design, likewise with the tablets, you see them from both sides.
 * It shows the detailed side of the foil pack. It's informative and gives a good idea of what it looks like and can be used freely.

I remember seeing a news report on atypical antipsychotics in the United States, and they showed an image of Zyprexa from Wikipedia. The box of Zyprexa is from Australia, but they were still able to show it, even if it were to come in bottles in the US, simply because it's the same brand logo and the same context. The usefulness of these generic images with foreign writing is just a waste of space, and not useful or informative at all. Capsules or tablets? I mean really, what's the mass difference? Not only that, it'd be misleading as you said, because nobody would see that anywhere, as they wouldn't see that other image on the paracetamol article. Kristoferb has no respect for what other editors have to say. Aside from generic images, I haven't seen this person contribute anything to the body of the articles. Editor182 (talk) 06:57, 27 June 2010 (UTC)

Kristoferb (talk) refuses to understand that the English version of Wikipedia requires English spelling. The image of the generic sertraline tablets from Turkey is not in English. The vast majority of readers can't read it and won't ever come across it. I have said this several times, NuclearWarfare (talk), another established user has reverted the edit following our dispute, but continued the edit warring regardless. This image does not belong here. Neither does the other image in paracetamol which was also reverted by myself and NuclearWarfare (talk), but this still isn't getting through. Take the images and post them on the correct version of Wikipedia. Wikipedia represents a worldwide view on subjects, but in a language relevant to that of the article. Take a look at this German article of sertraline. It is not simply a page translation, but a completely different article, different writing, different images where applicable. The 100 mg image isn't in dispute, that's not what this warring is about, it's concerning this generic image which is not suitable for the context of this article. Editor182 (talk) 05:41, 27 June 2010 (UTC)
 * The word "sertraline" is in English, and I think of the capsule vs. caplet situation as being of some importance, or at least of some interest, because thanks to the Tylenol poisoning scare a couple of decades ago, capsules were pretty much banned from U.S. markets. The fact they are still being used in Turkey may be of interest, though that fact might be out of scope of this particular article. ←Baseball Bugs What's up, Doc? carrots→ 07:23, 27 June 2010 (UTC)

I had a closer look at the image before, and it's actually "Sertralin", so it's not in English and neither is "Antidepresan". It's just not relevant to the English version of Wikipedia. It barely shows two white and pink capsules. The only difference is the medication is powdered on the inside, instead of a solid tablet. It's still the same dose, and it's not Extended Release or anything either. Three images lined up is too much, and this one just has no point. Even if it was the only image in the article, as you said, it would still be out of scope. Editor182 (talk)
 * It's not like it's written in Chinese or something - it's fairly clear what it is. There's no rule forbidding the use of photos that might have foreign writing, provided there's adequate explanation in the caption. And I have to say that as a picture, I like it better than the blue-and-white box picture, because I had to look 3 times before I saw that there were indeed pills sitting on the tinfoil. The pills need to be sitting on their own so they can be seen easily. That is, someone should re-shoot that photo. I think there's been overreaction on both sides. There's really nothing wrong with the Turkish photo as such. I'm just not convinced that it's needed. How many illustrations of a given pill do we need? It's not the Venus de Milo or something, it's just a freakin' pill. ←Baseball Bugs What's up, Doc? carrots→ 07:34, 27 June 2010 (UTC)

You're right, this has dragged on long enough, I'll revert the edit for the sake of moving on. Editor182 (talk) 08:30, 27 June 2010 (UTC)
 * This discussion was aggressively closed by Editor182 before reaching a conclusion on what should happen to poor quality image of 100 mg tablets. The image does not meet the proposed guideline on image quality and should be replaced as soon as possible with a properly shot and composed image. This is what the Guidelines say to do when an image is blurry and badly lit, as the image of 100 mg tablets unquestionably is. --Kristoferb (talk) 17:25, 28 June 2010 (UTC)
 * It's not too bad of an image, though it could be better. It's certainly readable. It's just a pill, it's not the Mona Lisa. ←Baseball Bugs What's up, Doc? carrots→ 21:05, 28 June 2010 (UTC)
 * Which is why I propose to leave it for now. But honestly, who takes a photo of tin foil with a flash?! --Kristoferb (talk) 03:19, 29 June 2010 (UTC)

Image - more
Alternative image for the 100mg is File:ZOLOFT (sertraline HCI) Crop.jpg, if you can accept one that's not English, otherwise the existing 100mg is probably sufficient until a better image is found in English, or maybe is superfluous and only File:Zoloft_bottles.jpg is necessary, I suggest either remove the 100mg or keep it until something better comes about, to much argument here, the image isn't THAT bad. — raeky ( talk 08:16, 30 June 2010 (UTC)
 * Your first example is pretty good. It's a closeup that's totally in focus, it shows the box, the wrappers, and the pill. It would be nice if it were in English, but that's not really a show-stopper, especially if someone could provide a translation for those who don't speak German or Dutch or whatever it is. The second example is good also. ←Baseball Bugs What's up, Doc? carrots→ 08:34, 30 June 2010 (UTC)


 * This image of generic capsules keeps being removed by Editor182. He takes issue with the spelling of sertraline in Turkish: sertralin. I think this image should be reinstated. There is no image of (a) a generic or (b) a capsule formulation. --Kristoferb (talk) 13:44, 30 June 2010 (UTC)

Image Consensus
Please note that back when this page was made a FA, it only had one product image. These additional images only jeopardize the FA status IMHO. Adding poor quality cell phone snapshots will put it more in danger of being delisted then having a forigen packaging, imho. The current layout of 3 images is acceptable to me, but if we had to loose one image I'd loose File:Sertraline_50mg.JPG. I do believe File:ZOLOFT_(sertraline_HCI)_Crop.jpg is superior over File:Zoloft_(sertraline).jpg. — raeky ( talk 15:22, 1 July 2010 (UTC)

Note: I would HIGHLY caution both Kristoferb and Editor182 from taking any further direct edits to the article and ONLY discuss their opinions on the talk page. — raeky ( talk 15:22, 1 July 2010 (UTC)

Meaningless sentence
"The unique effect of sertraline on dopaminergic neurotransmission may be related to its favorable action on cognitive functions.[7] " This sentence is by itself in the introduction. It doesn't describe what the "unique effect" is. So, this sentence needs to be moved to some point which follows a discussion of the effects of sertraline on ...yadda, or some discussion needs to be added before this sentence of the yadda, yadda. —Preceding unsigned comment added by 72.187.199.192 (talk) 21:11, 7 April 2011 (UTC)

Outdated: Suicide rates
Reading through this article I've done some surface research on the suicide side effects section and as of February, the ACNP have stated "More than 20,000 adults have been studied in clinical trials of SSRIs and other antidepressants … Analysis of the database found no relationship between SSRIs and suicidal attempts or actual suicides in adults." I have obviously not read any research papers associated with this, but if someone could confirm/deny this with the actual data, it would be great. I think it's very important because I assume a good proportion of the people who are reading this article are taking/will take the drug themselves, and telling them that they will experience increased likelihood of committing suicide is not the best thing for them, especially if it's not true, by way of self-fulfilling prophecy (refer to http://psycnet.apa.org/journals/rev/93/4/429.html cited by 321). --Frakkus (talk) 05:34, 15 October 2011 (UTC)

Weight Loss
This drug results in weight loss for some people. I am currently taking it for the past 6 weeks and have lost about 6 lbs. There are various websites on the net which state that for some it results in weight loss. There is a site especially created for this fact, http://www.zoloftweightloss.com. However, the article says weight isn't effected which isn't quite true — Preceding unsigned comment added by 98.169.167.183 (talk) 09:42, 16 July 2012 (UTC)

Secondary sourcing
I'm reluctant to BOLDly slap a primary on this article, but its really is not up to FA-class standards for wp:MEDRS sourcing, especially not for a High-importance subject. Many of the references are to primary sources that are far from current. Please, let's try to fix this. LeadSongDog come howl!  22:10, 6 December 2012 (UTC)

Unwarranted deletions
A huge swath of text was deleted from the article today with a following justification: ''Remove content based on "primary sources". Wikipedia's health-related content is based on secondary sources per WP:MEDRS. Feel free to restore the deleted content with citations to secondary sources.''

Most of the deleted text was based on high quality secondary sources (e.g text based on Cochran reviews was deleted). Doing a huge indiscriminate deletion only because some primary sources seemed to the deleter to be unsatisfactory and then leaving the resulting mess for somebody else to clean up, is wrong and borders on vandalism. MEDRS does not ban primary sources; they can be used occasionally, for example, in cases where only primary sources exist. Further, MEDRS is but a guideline, and has to be followed within reason. If following the guideline makes an article worse, the guideline should be WP:ignored.

Therefore, I restore the deleted text and suggest achieving a consensus that would improve the article. We shall discuss the changes on the talk page before carrying them out. Let us go through the contentious parts, paragraph by paragraph, and see if the old references can be updated and primary sources replaced by secondary sources whenever appropriate.

Further, I submit that some presumption against the deletion should exist for the parts of the text that were vetted during the FA process, which is most of the deleted text. WP:MEDRS existed in 2008 as well, nevertheless, the community, apparently, OK'd the use of primary sources. (Not saying that we cannot improve on that, of course)

The Sceptical Chymist (talk) 02:29, 17 April 2013 (UTC)


 * I removed or substantially edited content from 12 paragraphs in 16 edits - each with an explanatory edit summary - over three hours of careful reading and source-checking. That is, my work was not "indiscriminate". If I inadvertently removed content adequately supported by a relevant review, I apologise. I'd appreciate it if you could point me to such edits.


 * Can I point you to Vandalism, which says in part: "In particular, this word should not be used to refer to any contributor in good standing, or to any edits that might have been made in good faith. This is because if the edits were made in good faith, they are not vandalism. Assume good faith yourself—instead of calling the person who made the edits a "vandal", discuss your concerns with them. Comment on the content and substance of the edits, instead of making personal comments."?


 * Yes, WP:MEDRS is only a guideline. But it is a guideline. It is something we generally insist editors follow, unless there is a good and demonstrated reason for them not to. I've elaborated further on my concerns about this article's conflict with WP:NOR and WP:MEDRS below. --Anthonyhcole (talk · contribs · email) 05:14, 17 April 2013 (UTC)

Changes to the lead - not verfiable
This paragraph from the lead:

''The efficacy of sertraline for depression is similar to that of older tricyclic antidepressants, but its side effects are much less pronounced. Differences with newer antidepressants are subtler and also mostly confined to side effects.''

Was replaced by this:

''The efficacy of sertraline, like other SSRIs, is uncertain due to selective publishing of clinical trials by pharmaceutical companies--a tendency to publish the results of trials showing a positive effect and not publish the results of trials showing no effect or a negative effect. A 2008 meta-analysis of all published and some unpublished trials found "virtually no difference" in effectiveness between placebos and actual SSRIs for most patients, with the exception of a small difference in patients with very severe depression.''

Leaving aside the issue of misinterpretation of the two meta-analyses, these meta-analyses are inapplicable to sertraline because they did not include sertraline. Kirsch et al: “The researchers obtained data on all the clinical trials submitted to the FDA for the licensing of fluoxetine, venlafaxine, nefazodone, and paroxetine.” Fournier et al.:”In the present study, we combined data from 6 large-scale, placebo-controlled trials that comprised patients with a broad range of baseline symptom severity…Three studies used the tricyclic antidepressant imipramine14- 16 and 3 used the selective serotonin reuptake inhibitor paroxetine”

Thus, the cited studies have no bearing on efficacy of sertraline or comparative efficacy of sertraline and TCIs. The original sentence in the lead is simply a short summary of the corresponding chapters. I suggest restoring it, unless somebody wants to suggest a better summation. The Sceptical Chymist (talk) 02:58, 17 April 2013 (UTC)


 * Kirsch makes the point somewhere that all antidepressant manufacturers hide negative results. However, I don't want to get into a point-by-point discussion about this article just now (if ever). For the moment, you can do what you like with the lede. There is a much bigger problem with this article. --Anthonyhcole (talk · contribs · email) 04:33, 17 April 2013 (UTC)

It is unfortunate that data from sertraline trials could not be used in the meta-analyses, but you haven't mentioned why. It is because the data from four sertraline trials involving 486 patients that yielded negative results have not been made available by the pharmaceutical company. Given this, and the fact that all ssri's act to block the SERT and so have similar effects, I'd say it's necessary to report that the efficacy of this drug is uncertain. AmiLynch (talk) 15:27, 25 April 2013 (UTC)


 * First, let me repeat: both Kirsch’s and Fournier’s meta-analyses did not include sertraline and also included antidepressants other than SSRI’s (nefazodone – Kirsch, and imipramine – Fournier). Therefore, one has to be careful when extrapolating these data to a narrower class (SSRI) or to a single antidepressant (sertraline). As a matter of fact, the authors of both meta-analyses only talk about “antidepressant medication”. It is WP:OR to use these two meta-analysis in support of a statement that sertraline/SSRI efficacy is uncertain.
 * Okay, well then I guess I have to repeat that the only reason Kirsch's did not include sertraline is that he couldn't get all the data. The pharmaceutical companies did not make the figures Kirsch needed available for four different trials that showed no benefit for sertraline over placebo, so he had to exclude sertraline to avoid selection bias.  In regards to the other antidepressants that were analyzed, yes, Kirsch also showed that nefazodone wasn't significantly more effective than placebo, but that additional finding does not invalidate his results indicating that Prozac, Effexor, and Paxil are only as effective as placeboes for all but the most severely depressed patients. And Fournier looked at imipramine in addition to Paxil -- imipramine shows very strong serotonin reuptake inhibition.AmiLynch (talk) 19:19, 27 April 2013 (UTC)


 * Second, saying that "all ssri's act to block the SERT and so have similar effects” - therefore sertraline efficacy is uncertain, is not only WP:OR but also ignorant. Most SSRIs act on other receptors in addition to SERT; those are different for different SSRIs, (e.g. fluoxetine acts on 5HT receptors, paroxetine on M and NET, sertraline on sigma and DAT, escitalopram is the only truly selective SSRI). In addition, SSRIs have different metabolism and different penetration of the CNS and so they may have different efficacy.
 * Why do you keep putting this phrase back in the intro then: "Differences with newer antidepressants are subtler and also mostly confined to side effects."? All ssri's do act on the SERT primarily, hence the classification as SSRI's. The medical community credits this serotonin reuptake inhibition as the property that is responsible for SSRI's effectiveness, so it's fair to question the effectiveness of the whole class when this property is shown to have little effect.AmiLynch (talk) 19:19, 27 April 2013 (UTC)


 * Third, to say that “efficacy of sertraline like other SSRIs is uncertain” is to propound a fringe WP:POV contrary to the accepted medical consensus. For example, Fournier meta-analysis, which Ami claims to support her POV, states: “Antidepressant medication has been shown to be superior to placebo in thousands of controlled clinical trials over the past 5 decades.”
 * That is a statement from the beginning of the paper, not a conclusion of the study. Here is how the conclusion is summed up in Fournier's study:
 * "The present findings indicate that the efficacy of ADM treatment for depression varies considerably as a function of symptom severity. True drug effects (an advantage of ADM over placebo) were nonexistent to negligible among depressed patients with mild, moderate, and even severe baseline symptoms, whereas they were large for patients with very severe symptoms. For baseline severity scores on the HDRS less than 25, estimates of the magnitudes of drug/placebo differences did not meet either of the 2 thresholds for clinical significance proposed by NICE.20 Conversely, for patients with the highest levels of baseline depression severity, ADM was markedly superior to placebo."AmiLynch (talk) 19:19, 27 April 2013 (UTC)


 * Fourth, Ami tendentiously misrepresented the findings of the Kirsch's and Fournier's meta-analyses. The sentence “The efficacy of … SSRIs, is uncertain” is contrary to the statements of the authors themselves. Both meta-analyses found that antidepressants highly effective in patients with the most severe depression, while not being effective for the milder depression.
 * See above, or your own quotes below.AmiLynch (talk) 19:19, 27 April 2013 (UTC)


 * For example, contrary to Ami’s misinterpretation Fournier states “The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.”
 * Fournier further qualifies his conclusion: “Several studies have demonstrated that ADM is superior to placebo for patients diagnosed with dysthymia, a condition partly defined by lower symptom levels relative to MDD.25,26 The dysthymia studies indicate that ADM can produce a true drug effect in patients with mild or moderate depressive symptoms.” (Fournier)
 * The editorial lay summary of the Kirsch paper states: "the differences between drug and placebo were not clinically significant in clinical trials involving either moderately or very severely depressed patients, but did reach the criterion for trials involving patients whose mean initial depression scores were at the upper end of the very severe depression category (mean HRSD baseline ’ 28; Figures 2–4). Given these data, there seems little evidence to support the prescription of antidepressant medication to any but the most severely depressed patients, unless alternative treatments have failed to provide benefit."


 * Fifth, Ami did not explain why she deleted the following sentence: Treatment of panic disorder with sertraline results in a significant decrease of the number of panic attacks and in improved quality of life. For obsessive-compulsive disorder, sertraline is not as effective as cognitive behavioral therapy; the best results have been achieved by combining these two treatments.

The Sceptical Chymist (talk) 00:19, 26 April 2013 (UTC)


 * Whatever the reason was for not including sertraline into the Fournier or Kirsch, it was not included. Hence, they are not applicable here.


 * Further, the conjecture that sertraline is not effective for less severe depression is further undermined by trials demonstrating its efficacy for dysthimia (see article).


 * The best evidence for/against sertraline efficacy for depression would be a meta-analysis of sertraline trials for depression. This was done as a part of a comparative meta-analysis, which found that sertraline belongs to the group of more effective antidepressants: Mirtazapine, escitalopram, venlafaxine, and sertraline were significantly more efficacious than duloxetine, fluoxetine, fluvoxamine, paroxetine, and reboxetine... Clinically important differences exist between commonly prescribed antidepressants for both efficacy and acceptability in favour of escitalopram and sertraline. Sertraline might be the best choice when starting treatment for moderate to severe major depression in adults because it has the most favourable balance between benefits, acceptability, and acquisition cost.

The Sceptical Chymist (talk) 17:56, 28 April 2013 (UTC)

Compliance with WP:NOR and WP:MEDRS
My main concern with this article is its heavy reliance on reports of individual studies ("primary sources"). This appears to diametrically conflict with our policy, No original research (WP:NOR). It may be that the article accurately represents the views expressed in current "secondary sources" (scholarly textbooks, systematic reviews, etc. - the kind of sources prescribed in Identifying reliable sources (medicine), WP:MEDRS). It may be that the article cites the same studies those textbooks and reviews cite in support of each assertion. If that is the case, at the end of each assertion (or cluster of assertions if they're all drawn from the same review or textbook) there should be a footnote marker pointing to the source textbook or review. To be clear, citing supporting trials is fine (although usually unnecessary) provided you also cite the "secondary" source that uses them to make the point. Simply making a claim and supporting it with a selected trial result, without citing an independent secondary source that also makes the claim using that trial result, breaks WP:NOR. As it stands, this article doesn't appear to meet the current requirements for WP:GA or WP:FA. Those standards have evolved considerably over the years, as have our expectations with regard to the sourcing of safety and efficacy claims.

Another concern is the boldness of some claims in the article. I may address this in detail later, but I just want to register my concern for now. I've noticed confident claims here that don't adequately reflect the diffidence of the sources.

Finally, Kirsch points out the tiny difference between placebo effect and drug effect found in a comprehensive (including published and unpublished results) review of trials of antidepressants. I think we owe it to our readers to make the size of the therapeutic effect clear. --Anthonyhcole (talk · contribs · email) 04:33, 17 April 2013 (UTC)


 * Since no one has addressed my concern about this article's heavy reliance on "primary sources" and apparent WP:OR, tomorrow I shall strip all efficacy and safety claims from this article that are based on such sources, per WP:MEDRS. If there is anyone watching this page with an interest in keeping those claims, the simplest way to do so would be to find the review or textbook that (I assume) each claim is based on and replace the litany of citations to primary sources with a citation to that secondary source.


 * I may do so myself, as I go through the article tomorrow, if I have the time. If I don't, I'll just strip it out and find good WP:MEDRS-compliant sources later, if someone hasn't beaten me to the task. It shouldn't be too hard. --Anthonyhcole (talk · contribs · email) 09:36, 14 October 2013 (UTC)

How is this drug synthesized?
Someone needs to post how this drug is synthesized. 2602:306:C518:6C40:505A:5C79:DCDB:627E (talk) 12:28, 26 May 2013 (UTC)

FAR review
Anthony brought up concerns about the referencing last Oct. This has not been dealt with. I have thus nominated this article for FAR. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:09, 30 January 2014 (UTC)
 * |TRIP - TRIP has a lot of good, secondary evidence to use if anyone fancies having a go with this article. --— Cyclonenim | Chat 11:14, 31 January 2014 (UTC)

Sexual side effects
I think this section needs to be expanded. It should look more like this:


 * Like other SSRIs, sertraline is associated with sexual side effects. Specifically, common side effects include difficulty becoming aroused, lack of interest in sex, and anorgasmia (trouble achieving orgasm). Genital anesthesia, loss of or decreased response to sexual stimuli, and ejaculatory anhedonia are also possible. Although usually reversible, for some people these effects are long-term and may persist after drug treatment is discontinued.


 * The observed frequency of sexual side effects depends greatly on whether they are reported by patients spontaneously, as in the manufacturer's trials, or actively solicited by the physicians. There have been several double-blind studies of sexual side effects comparing sertraline with placebo or other antidepressants. While nefazodone (Serzone), bupropion (Wellbutrin) and reboxetine (Edronax) did not have negative effects on sexual functioning, 67% of men on sertraline experienced ejaculation difficulties vs. 18% before the treatment (or 61% vs. 0% according to another paper). Similarly, in a group of women who initially did not have difficulties achieving orgasm, 41% acquired this problem during treatment with sertraline. A 40% rate of orgasm dysfunction (vs. 9% for placebo) on sertraline was observed in a mixed group in another study. Sexual arousal disorder, defined as "inadequate lubrication and swelling for women and erectile difficulties for men", occurred in 12% of patients on sertraline as compared with 1% of patients on placebo. The mood improvement resulting from the treatment with sertraline sometimes counteracted these side effects, so that sexual desire and overall satisfaction with sex stayed the same as before the sertraline treatment. However, under the action of placebo the desire and satisfaction slightly improved.

Unfortunately this version is meeting some resistance. Can others help/chime in? AmiLynch (talk) 16:30, 14 February 2015 (UTC)
 * Sure these refs are not very good
 * -> not pubmed indexed
 * -> primary source
 * -> case reports
 * -> case reports
 * Please read WP:MEDRS Doc James  (talk · contribs · email) 16:52, 14 February 2015 (UTC)

Bombshell on studies on sertraline
Wow, this paper by David Healy (psychiatrist) and Dinah Cattell is quite the bombshell. How should we work this into the article? The evidence of publication bias? As I read it, the CMD-linked (i.e. ghostwritten) articles report universally positive results (100% of 25 clinical trials), while of the 41 non-CMD (non-ghostwritten) articles, "3 report ambiguous findings for sertraline, 20 report negative findings and 18 report positive findings".-- Elvey (t•c) 05:05, 17 January 2016 (UTC)

suicide
For example, there's this paragraph in the paper: The second issue relates to the correspondence between published articles and raw data. The current CMD series throws up issues of concern in this area. First, one study in this series had one patient on sertraline who committed suicide, and three others on sertraline who reported increasing suicidal ideation necessitating treatment discontinuation, in contrast to just one case of emergent suicidality on a comparable drug and no problems on placebo. There is no reference to these data in the final published article. Second, of the six published paediatric psychopharmacology CMD articles, only one article mentions one suicidal act. There were in fact six suicidal acts on sertraline and three further cases of suicidality in the subject group from which these articles come, including four suicidal acts in 44 patients with depression given sertraline, which is a rate of 9% ( Pfizer Expert Report, 1997). The effects of sertraline in paediatric depression were outlined by Alderman et al ( 1998), who reported only the adverse events that occurred in more than 10% of patients.

-- Elvey (t•c) 05:05, 17 January 2016 (UTC)

Sertraline: sigma agonist, antagonist, or what?
I see the sertraline article has been added to Category:Sigma antagonists, yet we don't have any mention of this in the article. Given that this article was previously in Category:Sigma agonists (see this diff), this is a non-trivial distinction.

It looks to my layman's eye like "antagonist" is perhaps more likely to be correct: see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881105/. However, this: https://www.ncbi.nlm.nih.gov/pubmed/24508523 says only that sertraline "may be" an antagonist, and web searches show a lot of discussion on various non-WP:MEDRS Internet fora as to whether it is one of the other. I have no medical knowledge whatsoever, so I'm not in a position to judge: it would be nice if someone with actual medical knowledge could review this article, and add some mention of it in the article itself, with a relevant cite.

Note: I have also posted this request for clarification on this to Wikipedia talk:WikiProject Medicine. -- The Anome (talk) 23:42, 25 August 2017 (UTC)

Medical uses: Sertraline is not approved for children, except for those with OCD
This sentence is false. It is approved for children, but I do not know how to add this in to the article, nor do I have a source to support this. Thank you, User:WikiJanitorPerson ☎️/🍌 20:45, 11 September 2021 (UTC)