Antidepressant Drug Therapy

What are antidepressant drugs?

For many people in the general population, antidepressant drugs help lessen their depressive symptoms. With proper treatment, often including antidepressants, 70 to 80 percent of people with major depression can experience a great reduction in symptoms. However, antidepressant drugs might not work for all patients. Taking antidepressant drugs will need a doctor's prescription and ongoing supervision. Some patients may experience side effects. It is important that we continue to research how effective anti-depressant drugs are at helping people on dialysis with depression.

How do antidepressants work?

Chemicals called neurotransmitters are needed for our brains to function normally. They also help us control our mood and impact how we eat, sleep, think and deal with pain, among other things. It is believed that some illnesses, including depression, are caused by neurotransmitters, including one called serotonin, being out of balance. Drugs, such as sertraline and fluoxetine, restore this chemical balance in the brain, and thus are used to treat depression, obsessive-compulsive disorder and anxiety disorders.

Antidepressant drugs in the ASCEND trial

Sertraline (trade name ZOLOFT), an antidepressant drug in a group of drugs called selective serotonin reuptake inhibitors (SSRIs), will be used in the ASCEND trial. Sertraline has shown that it can be effective in kidney disease patients and that it is safe for patients with heart disease as it is metabolized to an inactive form before being excreted via the kidneys. It is also inexpensive, available in generic form and in oral tablets of 25, 50, and 100 milligram strengths. The recommended dose is 25 to 200 milligrams by mouth once daily, taken either in the morning or evening, with or without food.

In the ASCEND trial, some patients participating in the treatment phase will be randomly chosen to receive Sertraline. To reduce the risk of side effects, this medication is started at a low dose (25 milligrams). Patients undergo two weekly surveys that assess their medical condition and response to Sertraline. These surveys help measure changes in the patient’s depressive symptoms, identify any risk of developing side effects, and inform the decision to increase or decrease the dose of Sertraline. Gradually, the dose is increased, at weekly intervals, until the desired response is seen.

At the end of 12 weeks, if there is significant improvement in depressive symptoms, both patient and doctor may choose to continue the drug therapy outside the study. If the patient decides not to continue treatment with the drug or is not feeling better with the drug, we will slowly reduce the Sertraline dose over a few weeks until it is stopped completely. We will communicate with patients’ regular doctors during this time to smoothly transition the patients back to their regular care.

Learn more about Sertraline in the National Institutes of Health library.