Zoloft - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

ZOLOFT A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AMES N. P A...

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ZOLOFT A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©2003 by ICON Group International, Inc. Copyright ©2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Zoloft: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83613-2 1. Zoloft-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on Zoloft. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON ZOLOFT ..................................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Zoloft............................................................................................. 4 The National Library of Medicine: PubMed .................................................................................. 7 CHAPTER 2. NUTRITION AND ZOLOFT ........................................................................................... 25 Overview...................................................................................................................................... 25 Finding Nutrition Studies on Zoloft............................................................................................ 25 Federal Resources on Nutrition ................................................................................................... 26 Additional Web Resources ........................................................................................................... 26 CHAPTER 3. ALTERNATIVE MEDICINE AND ZOLOFT ..................................................................... 29 Overview...................................................................................................................................... 29 National Center for Complementary and Alternative Medicine.................................................. 29 Additional Web Resources ........................................................................................................... 32 General References ....................................................................................................................... 34 CHAPTER 4. CLINICAL TRIALS AND ZOLOFT .................................................................................. 35 Overview...................................................................................................................................... 35 Recent Trials on Zoloft................................................................................................................. 35 Keeping Current on Clinical Trials ............................................................................................. 38 CHAPTER 5. PATENTS ON ZOLOFT .................................................................................................. 41 Overview...................................................................................................................................... 41 Patents on Zoloft.......................................................................................................................... 41 Patent Applications on Zoloft ...................................................................................................... 53 Keeping Current .......................................................................................................................... 58 CHAPTER 6. BOOKS ON ZOLOFT ..................................................................................................... 61 Overview...................................................................................................................................... 61 Book Summaries: Online Booksellers........................................................................................... 61 Chapters on Zoloft........................................................................................................................ 62 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 65 Overview...................................................................................................................................... 65 NIH Guidelines............................................................................................................................ 65 NIH Databases............................................................................................................................. 67 Other Commercial Databases....................................................................................................... 69 APPENDIX B. PATIENT RESOURCES ................................................................................................. 71 Overview...................................................................................................................................... 71 Patient Guideline Sources............................................................................................................ 71 Finding Associations.................................................................................................................... 73 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 75 Overview...................................................................................................................................... 75 Preparation................................................................................................................................... 75 Finding a Local Medical Library.................................................................................................. 75 Medical Libraries in the U.S. and Canada ................................................................................... 75 ONLINE GLOSSARIES.................................................................................................................. 81 Online Dictionary Directories ..................................................................................................... 81 ZOLOFT DICTIONARY................................................................................................................. 83 INDEX .............................................................................................................................................. 114

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with Zoloft is indexed in search engines, such as www.google.com or others, a nonsystematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about Zoloft, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to Zoloft, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on Zoloft. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to Zoloft, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on Zoloft. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON ZOLOFT Overview In this chapter, we will show you how to locate peer-reviewed references and studies on Zoloft.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and Zoloft, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “Zoloft” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Exercise Your Right to Happiness Source: Health. p. 17. January/February 2001. Summary: Exercise works as well as drugs in treating depression according to Duke University psychologists. The researchers recruited 156 men and women ages 50 and older who suffered from depression. One group walked or jogged for 30 minutes, 3 days a week. A second group took the antidepressant Exerci, and the third group both exercised and took the medication. At the end of 4 months, all three groups were significantly better. The researchers checked back 6 months after the study ended to see how people were faring on their own. In the combination group, 31 percent of the subjects had fallen back into depression; in the antidepressant-only group, 38 percent. Among the exercisers, only 8 percent saw their symptoms return. Lead researcher James Blumenthal concludes that "exercise is a viable alternative to drugs."

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Federally Funded Research on Zoloft The U.S. Government supports a variety of research studies relating to Zoloft. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to Zoloft. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore Zoloft. The following is typical of the type of information found when searching the CRISP database for Zoloft: •

Project Title: EXERCISE TRAINING AND DEPRESSION IN OLDER ADULTS Principal Investigator & Institution: Blumenthal, James A. Professor; Duke University Durham, NC 27706 Timing: Fiscal Year 2001; Project Start 01-DEC-2000; Project End 30-NOV-2001 Summary: The purpose of this study is to determine the efficacy of exercise training relative to pharmacologic treatment in clinically depressed older adults aged 50 years and older. This study is a randomized controlled trial of exercise training and/or pharmacologic treatment (sertraline or Zoloft) in which subjects undergo comprehensive assessments including a clinical diagnostic evaluation, exercise treadmill testing, and medical examinations. Following this assessment, subjects are classified as mild/moderately or severely depressed and within these groups randomly assigned to one of three treatment groups: (a) medication (Zoloft); (b) aerobic exercise training; or (c) medication and exercise. Following the completion of the 4-month treatment program, subjects undergo a third evaluation at 6-month follow-up, and a fourth evaluation at 1 year follow-up. This study hypothesizes that: (1) an aerobic exercise program is feasible among older depressed patients, and the extent of improvement in cardiorespiratory function will be comparable to that of normal subjects; (2) an aerobic exercise program will be associated with comparable reductions in depression in mild-moderately depressed patients relative to mild-moderately depressed patients receiving medication alone; (3) drug therapy will be superior to exercise alone in the treatment of severely depressed patients; (4) aerobic exercises combined with medication will be superior to medication alone among severely depressed patients; (5) aerobic exercise training in mild-moderately depressed patients will be associated with less relapse at 6 months than patients receiving drug therapy alone; and (6) at 6 month and 1 year follow-ups, there will be greater relapse in the severely depressed patients receiving drug alone compared to patients who receive both drug and exercise training. This past year, we recruited 1 additional participant, a white male who was classified as severely depressed. This participant dropped out of the study following his Time 1 assessment. One hundred and fifty-six subjects have been enrolled during the past four years. Of

2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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these 156 subjects, 43 are male and 113 are female; 66 are classified as severe and 90 are classified as mild/moderate depressives. The ethnic breakdown of these 156 subjects is as follows: 133 Caucasions ( 39 male, 94 female); 18 African-Americans (3 male, 15 female); 3 Hispanic subjects ( 1 male, 2 female); 1 Native American female; and 1 Iranian female. Our protocol states that our ethnic breakdown will be 75% white and 25% minority, which we attempted to reach by participation in health fairs, contacting churches, and presentations. However, our total ethnic minority recruitment was 14.7%. In addition, our gender breakdown is currently 72% female and 28% male, which meets our protocol criteria (50% female and 50% male). In total, thirty-two (21%) subjects dropped out prematurely from the study (7 from medication only, 14 from exercise only, and 11 from exercise/medication). All active subjects (134 participants) have completed the four-month treatment and 6-month follow-up portions of the study. To date, 80 active subjects have completed the 18-month follow-up portions of the study. There are no plans to recruit further patients. Future plans include completing the 18-month follow-up assessments for all active participants, which is expected to continue through September, 1999. Additionally, we will be working on data analyses and manuscript publications and presentations. The information obtained from this study will have significant practical implications for the treatment of depression by clarifying the psychological benefits of exercise for older adults. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENETIC ANALYSIS OF NEMATODE EGG LAYING Principal Investigator & Institution: Horvitz, H R. Professor; Biology; Massachusetts Institute of Technology Cambridge, MA 02139 Timing: Fiscal Year 2001; Project Start 01-JAN-1978; Project End 31-DEC-2004 Summary: The long-term objective of this proposal is to understand how genes specify the structure, functioning and development of a behavioral system. Toward this end, the anatomically simple egg-laying system of the nematode Caenorhabditis elegans will be analyzed. Mutants abnormal in egg laying will be used to define both cells that act in egg laying and genes that control the development and functioning of those cells. Four distinct components of the egg-laying system will be analyzed: the vulva (through which eggs are laid); the egg-laying musculature; the nerve cells that directly control the egg-laying musculature; and nerve cells that indirectly regulate egg laying. Vulval development provides an excellent model for both intercellular signaling (how cells communicate) and morphogenesis (how cells generate complex three-dimensional structures). The studies of intercellular signaling in vulval development should reveal the normal biological functions and interactions of genes with human counterparts responsible for cancer. The studies of vulval morphogenesis focus on genes that are involved in the synthesis of specific carbohydrates and that appear to be similar to human genes involved in connective tissue disorders and aging. The contraction of muscles in general and of the C. elegans egg-laying muscles in particular requires the movement of ions through channels that span muscle membranes. The studies of the egg-laying musculature focus on a new class of ion channels and promise to establish new biological roles for ion channels and suggest candidate genes for diseases in which such channels are abnormal. Studies of the two classes of nerve cells (HSNs and VCs) that innervate the egg-laying muscles should help establish molecular genetic mechanisms responsible for many features of nerve cell development and activity, including the determination of cell identity, the outgrowth and branching of processes, and the formation and functioning of synapses (which allow communication between a nerve cell and its targets). Many genes involved in the development of these nerve cells

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have human counterparts associated with disease. Finally, nerve cells that control both egg laying and other behaviors, e.g., locomotion, will be identified and analyzed based on their effects on how the animal modulates its behavior in response to its environment and experience. Some of these cells communicate using the neurotransmitter serotonin, the target of major pharmaceutical agents used to treat depression -- Prozac, Paxil and Zoloft.. In addition, how the environment and experience modulate behavior is a fundamental problem in neuroscience, and these studies should establish cellular and molecular mechanisms responsible for how sensory stimuli regulate behavior and how information about past experience is stored and retrieved. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: METHOD FOR MAKING AN IMPROVED ST JOHN'S WORT PRODUCT Principal Investigator & Institution: Castor, Trevor P. President & Chief Executive Officer; Aphios Corporation 3-E Gill St Woburn, MA 01801 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-DEC-2002 Summary: (Adapted from the application): The goal of this Phase I/Phase II Fast Track project is to develop an improved St. John's Wort product which can be manufactured in a standardized and reproducible manner. St. John's Wort contains multiple bioactive compounds that have been used in a wide variety of ailments, most notably endogenous depression. The approach involves the use of supercritical fluids and near-critical fluids with and without polar cosolvents such as alcohols (trademarked as SuperFluids). These fluids are gases such as carbon dioxide which when compressed exhibit enhanced thermodynamic properties that can be fine-tuned for rapid and selective extraction of bioactive molecules. In Phase I, optimal conditions for selective SuperFluids extraction of and chromatographic purification of St. John's Wort will be established. In preliminary studies, this was accomplished by following the extraction of bioactive compounds with super critical carbon dioxide with 0 to 20% methanol. The results of Phase I studies will be used to develop a large scale manufacturing process. In a Phase II investigation, the conditions for selective extraction and chromatographic purification of bioactive compounds will be further optimized in terms of mechanical components, enhancement devices and operating parameters. Finally, it is proposed to design, build and test a pilot-scale prototype plant that could operate under cGMP conditions. Paracelsian (Ithaca, NY) will perform serotonin uptake assays on contract. PROPOSED COMMERCIAL APPLICATION: Among the most widely prescribed antidepressants in the United States are Prozac from Eli Lilly, Zoloft from Pfizer and Paxil from SmithKline Beecham. The worldwide sales of the top selling antidepressants are approximately $4.8 billion. As people experience adverse side-effects from prescription antidepressants, there has been a concomitant rise in the use of St. John's Wort and other herbs as natural anti- depressants. This Phase I/Phase II Fast Track SBIR project should lead to the development of a biologically-enhanced, stable and standardized St. John's Wort product that can be manufactured under cGMP conditions to provide a natural alternative with reduced side effects of Prozac, Pfizer and Paxil, and thus satisfy a burgeoning market demand in the $4.8 billion antidepressant marketplace. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SYNTHESIS BENZAZEPINE

OF

FLUOXETINE

ANALOGS:

SUBSTITUTED

Principal Investigator & Institution: Okoro, Cosmas O.; Tennessee State University 3500 Centennial Blvd Nashville, TN 37203

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Timing: Fiscal Year 2003; Project Start 01-JAN-2003; Project End 31-DEC-2006 Summary: Fluoxetine (Prozac) is a commonly prescribed antidepressant that targets the serotonin transporter. Unlike tricyclics, such as imipramine, fluoxetine has little effect on other receptors, resulting in a lower occurrence of sedative and cardiovascular side effects. The semi-rigid sertraline (Zoloft) has a mechanism similar to fluoxetine, but is superior, because it confers lesser sedation than fluoxetine, in addition to being short acting. The primary objective of the present study is the design and synthesis of conformationally-restricted derivatives of fluoxetine, as potential pharmacologically active compounds. Both (R) and (S)-fluoxetine are flexible molecules. The (S)-isomer displays prolonged duration in man, which may contribute to side effects. Flexible molecules may have more than one site of action, with one preferred conformation at the receptor site. Side effects observed may be due to a low-energy conformation of fluoxetine at a second site. The synthesis of analogs in which the molecular framework of the pharmacophore is "locked" into semi-rigid form will allow a full study of the conformational aspects of drug action. The consideration of a benzazepine moiety in the proposed compounds was made in the light of cyclized version of norfluoxetine, which is active. Although amphetamines, cocaine and antidepressants profoundly affect human behavior, their underlyling mechanisms of action are unknown. It is postulated that the interactions of antidepressants with transporters account for the primary action of these drugs. The synthesized compounds will be used to study neurotransmitter uptake mechanisms, i.e. how transporters clear transmitters from the synaptic cleft after they are released from the nerve terminal. This part of the work will be done in colloboration with Dr. Louis J. DeFelice, Professor of Pharmacology and Neuroscience at Vanderbilt University School of Medicine. The research project will ultimately provide novel compounds for the treatment of depression and mental illness. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with Zoloft, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “Zoloft” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for Zoloft (hyperlinks lead to article summaries):

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PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A case of subacute onset dementia due to sertraline. Author(s): Chakraborty D, Agarwal CS, Rohatagi R. Source: J Assoc Physicians India. 2003 March; 51: 323-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12839368&dopt=Abstract

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A comparison of characteristics of depressed patients and efficacy of sertraline and amitriptyline between Japan and the West. Author(s): Ohishi M, Kamijima K. Source: Journal of Affective Disorders. 2002 July; 70(2): 165-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12117628&dopt=Abstract

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A double-blind, placebo-controlled study of sertraline in the prevention of depression in stroke patients. Author(s): Rasmussen A, Lunde M, Poulsen DL, Sorensen K, Qvitzau S, Bech P. Source: Psychosomatics. 2003 May-June; 44(3): 216-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12724503&dopt=Abstract

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A double-blind, placebo-controlled trial of sertraline for depressive symptoms in patients with stable, chronic schizophrenia. Author(s): Mulholland C, Lynch G, King DJ, Cooper SJ. Source: Journal of Psychopharmacology (Oxford, England). 2003 March; 17(1): 107-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12680747&dopt=Abstract

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A pilot double blind placebo controlled trial of sertraline with naltrexone in the treatment of opiate dependence. Author(s): Farren CK, O'Malley S. Source: The American Journal on Addictions / American Academy of Psychiatrists in Alcoholism and Addictions. 2002 Summer; 11(3): 228-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12202015&dopt=Abstract

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A randomized trial of a specific adherence enhancement program in sertraline-treated adults with major depressive disorder in a primary care setting. Author(s): Kutcher S, Leblanc J, Maclaren C, Hadrava V. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2002 April; 26(3): 591-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11999913&dopt=Abstract

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A randomized trial of sertraline as a cessation aid for smokers with a history of major depression. Author(s): Covey LS, Glassman AH, Stetner F, Rivelli S, Stage K. Source: The American Journal of Psychiatry. 2002 October; 159(10): 1731-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12359680&dopt=Abstract

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Acute efficacy of fluoxetine versus sertraline and paroxetine in major depressive disorder including effects of baseline insomnia. Author(s): Fava M, Hoog SL, Judge RA, Kopp JB, Nilsson ME, Gonzales JS. Source: Journal of Clinical Psychopharmacology. 2002 April; 22(2): 137-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11910258&dopt=Abstract

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Adverse events in users of sertraline: results from an observational study in psychiatric practice in The Netherlands. Author(s): Meijer WE, Heerdink ER, van Eijk JT, Leufkens HG. Source: Pharmacoepidemiology and Drug Safety. 2002 December; 11(8): 655-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12512241&dopt=Abstract

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An 8-week multicenter, parallel-group, double-blind, placebo-controlled study of sertraline in elderly outpatients with major depression. Author(s): Schneider LS, Nelson JC, Clary CM, Newhouse P, Krishnan KR, Shiovitz T, Weihs K; Sertraline Elderly Depression Study Group. Source: The American Journal of Psychiatry. 2003 July; 160(7): 1277-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12832242&dopt=Abstract

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An unusual presentation of sertraline and trazodone overdose. Author(s): Adson DE, Erickson-Birkedahl S, Kotlyar M. Source: The Annals of Pharmacotherapy. 2001 November; 35(11): 1375-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11724086&dopt=Abstract

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Analysis of sertraline (Zoloft) and its major metabolite in postmortem specimens by gas and liquid chromatography. Author(s): Logan BK, Friel PN, Case GA. Source: Journal of Analytical Toxicology. 1994 May-June; 18(3): 139-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8065122&dopt=Abstract

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Antidepressant side effects in depression patients treated in a naturalistic setting: a study of bupropion, moclobemide, paroxetine, sertraline, and venlafaxine. Author(s): Vanderkooy JD, Kennedy SH, Bagby RM. Source: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 2002 March; 47(2): 174-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11926080&dopt=Abstract

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Are paroxetine, fluoxetine, and sertraline equally effective for depression? Author(s): Straton JB, Cronholm P. Source: The Journal of Family Practice. 2002 March; 51(3): 285. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11978244&dopt=Abstract

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Association of maternal sertraline (Zoloft) therapy and transient neonatal nystagmus. Author(s): Oca MJ, Donn SM. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 1999 September; 19(6 Pt 1): 460-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10685280&dopt=Abstract

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Characterizing the effects of sertraline in post-traumatic stress disorder. Author(s): Davidson JR, Landerman LR, Farfel GM, Clary CM. Source: Psychological Medicine. 2002 May; 32(4): 661-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12102380&dopt=Abstract

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Chronic depression and comorbid personality disorders: response to sertraline versus imipramine. Author(s): Russell JM, Kornstein SG, Shea MT, McCullough JP, Harrison WM, Hirschfeld RM, Keller MB. Source: The Journal of Clinical Psychiatry. 2003 May; 64(5): 554-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12755659&dopt=Abstract

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Clinical outcome and tolerability of sertraline in major depression: a study with plasma levels. Author(s): Mauri MC, Laini V, Cerveri G, Scalvini ME, Volonteri LS, Regispani F, Malvini L, Manfre S, Boscati L, Panza G. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2002 April; 26(3): 597-601. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11999914&dopt=Abstract

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Clinical outcomes following a trial of sertraline in rheumatoid arthritis. Author(s): Slaughter JR, Parker JC, Martens MP, Smarr KL, Hewett JE. Source: Psychosomatics. 2002 January-February; 43(1): 36-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11927756&dopt=Abstract

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Clinical pharmacokinetics of sertraline. Author(s): DeVane CL, Liston HL, Markowitz JS. Source: Clinical Pharmacokinetics. 2002; 41(15): 1247-66. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12452737&dopt=Abstract

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Cognitive and psychomotor effects of paroxetine and sertraline on healthy elderly volunteers. Author(s): Furlan PM, Kallan MJ, Ten Have T, Pollock BG, Katz I, Lucki I. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2001 Fall; 9(4): 429-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11739070&dopt=Abstract

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Comment: sudden cardiac death with clozapine and sertraline combination. Author(s): Gillespie JA. Source: The Annals of Pharmacotherapy. 2001 December; 35(12): 1671-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11793642&dopt=Abstract

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Comparative outcomes for individual cognitive-behavior therapy, supportiveexpressive group psychotherapy, and sertraline for the treatment of depression in multiple sclerosis. Author(s): Mohr DC, Boudewyn AC, Goodkin DE, Bostrom A, Epstein L. Source: Journal of Consulting and Clinical Psychology. 2001 December; 69(6): 942-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11777121&dopt=Abstract

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Complex modulation of human motor cortex excitability by the specific serotonin reuptake inhibitor sertraline. Author(s): Ilic TV, Korchounov A, Ziemann U. Source: Neuroscience Letters. 2002 February 15; 319(2): 116-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11825684&dopt=Abstract

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Cross-sensitivity between paroxetine and sertraline. Author(s): Warnock CA, Azadian AG. Source: The Annals of Pharmacotherapy. 2002 April; 36(4): 631-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11918512&dopt=Abstract

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Death resulting from asthma associated with sertraline “overdose”. Author(s): Spigset O, Ostrom M, Eriksson A. Source: The American Journal of Forensic Medicine and Pathology : Official Publication of the National Association of Medical Examiners. 2001 December; 22(4): 419-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11764917&dopt=Abstract

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Depression and panic disorder after heart transplantation--treatment with sertraline. Author(s): Hesslinger B, Van de Loo A, Klecha D, Harter M, Schmidt-Schweda S. Source: Pharmacopsychiatry. 2002 January; 35(1): 31-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11819158&dopt=Abstract

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Differential time course of cytochrome P450 2D6 enzyme inhibition by fluoxetine, sertraline, and paroxetine in healthy volunteers. Author(s): Liston HL, DeVane CL, Boulton DW, Risch SC, Markowitz JS, Goldman J. Source: Journal of Clinical Psychopharmacology. 2002 April; 22(2): 169-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11910262&dopt=Abstract

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Dissociative symptoms from combined treatment with sertraline and trazodone. Author(s): Lacy T, Mathis M. Source: The Journal of Neuropsychiatry and Clinical Neurosciences. 2003 Spring; 15(2): 241-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12724468&dopt=Abstract

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Do bupropion SR and sertraline differ in their effects on anxiety in depressed patients? Author(s): Trivedi MH, Rush AJ, Carmody TJ, Donahue RM, Bolden-Watson C, Houser TL, Metz A. Source: The Journal of Clinical Psychiatry. 2001 October; 62(10): 776-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11816866&dopt=Abstract

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Double-blind placebo-controlled pilot study of sertraline in military veterans with posttraumatic stress disorder. Author(s): Zohar J, Amital D, Miodownik C, Kotler M, Bleich A, Lane RM, Austin C. Source: Journal of Clinical Psychopharmacology. 2002 April; 22(2): 190-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11910265&dopt=Abstract

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Double-blind switch study of imipramine or sertraline treatment of antidepressantresistant chronic depression. Author(s): Thase ME, Rush AJ, Howland RH, Kornstein SG, Kocsis JH, Gelenberg AJ, Schatzberg AF, Koran LM, Keller MB, Russell JM, Hirschfeld RM, LaVange LM, Klein DN, Fawcett J, Harrison W. Source: Archives of General Psychiatry. 2002 March; 59(3): 233-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11879161&dopt=Abstract

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Double-blind, placebo-controlled comparison of the efficacy of sertraline as treatment for a major depressive episode in patients with remitted schizophrenia. Author(s): Addington D, Addington J, Patten S, Remington G, Moamai J, Labelle A, Beauclair L. Source: Journal of Clinical Psychopharmacology. 2002 February; 22(1): 20-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11799338&dopt=Abstract

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Duration of therapy and health care costs of fluoxetine, paroxetine, and sertraline in 6 health plans. Author(s): Polsky D, Onesirosan P, Bauer MS, Glick HA. Source: The Journal of Clinical Psychiatry. 2002 February; 63(2): 156-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11874218&dopt=Abstract

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Early improvement predicts endpoint remission status in sertraline and placebo treatments of panic disorder. Author(s): Pollack MH, Rapaport MH, Fayyad R, Otto MW, Nierenberg AA, Clary CM. Source: Journal of Psychiatric Research. 2002 July-August; 36(4): 229-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12191627&dopt=Abstract

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Effect of increasing the dose and duration of sertraline trial in the treatment of depressed nursing home residents. Author(s): Weintraub D, Streim JE, Datto CJ, Katz IR, DiFilippo SD, Oslin DW. Source: Journal of Geriatric Psychiatry and Neurology. 2003 June; 16(2): 109-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12801161&dopt=Abstract

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Effect of sertraline hydrochloride on cardiac autonomic dysfunction in patients with hemodialysis-induced hypotension. Author(s): Yalcin AU, Kudaiberdieva G, Sahin G, Gorenek B, Akcar N, Kuskus S, Bayrak F, Timuralp B. Source: Nephron. Physiology [electronic Resource]. 2003 January; 93(1): P21-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12411727&dopt=Abstract

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Effect of the selective serotonin reuptake inhibitor sertraline on gastric sensitivity and compliance in healthy humans. Author(s): Ladabaum U, Glidden D. Source: Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society. 2002 August; 14(4): 395-402. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12213107&dopt=Abstract

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Effects of long term treatment with sertraline (Zoloft) simulating hypothyroidism in an adolescent. Author(s): Harel Z, Biro FM, Tedford WL. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 1995 March; 16(3): 232-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7779834&dopt=Abstract

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Effects of sertraline treatment on plasma cortisol, prolactin and thyroid hormones in female depressed patients. Author(s): Sagud M, Pivac N, Muck-Seler D, Jakovljevic M, Mihaljevic-Peles A, Korsic M. Source: Neuropsychobiology. 2002; 45(3): 139-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11979064&dopt=Abstract

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Efficacy of intermittent, luteal phase sertraline treatment of premenstrual dysphoric disorder. Author(s): Halbreich U, Bergeron R, Yonkers KA, Freeman E, Stout AL, Cohen L. Source: Obstetrics and Gynecology. 2002 December; 100(6): 1219-29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12468166&dopt=Abstract

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Efficacy of sertraline in preventing relapse of posttraumatic stress disorder: results of a 28-week double-blind, placebo-controlled study. Author(s): Davidson J, Pearlstein T, Londborg P, Brady KT, Rothbaum B, Bell J, Maddock R, Hegel MT, Farfel G. Source: The American Journal of Psychiatry. 2001 December; 158(12): 1974-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11729012&dopt=Abstract

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Efficacy of sertraline in severe generalized social anxiety disorder: results of a doubleblind, placebo-controlled study. Author(s): Liebowitz MR, DeMartinis NA, Weihs K, Londborg PD, Smith WT, Chung H, Fayyad R, Clary CM. Source: The Journal of Clinical Psychiatry. 2003 July; 64(7): 785-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12934979&dopt=Abstract

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Efficacy of sertraline in the long-term treatment of obsessive-compulsive disorder. Author(s): Koran LM, Hackett E, Rubin A, Wolkow R, Robinson D. Source: The American Journal of Psychiatry. 2002 January; 159(1): 88-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11772695&dopt=Abstract

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Efficacy of sertraline in the treatment of children and adolescents with major depressive disorder: two randomized controlled trials. Author(s): Wagner KD, Ambrosini P, Rynn M, Wohlberg C, Yang R, Greenbaum MS, Childress A, Donnelly C, Deas D; Sertraline Pediatric Depression Study Group. Source: Jama : the Journal of the American Medical Association. 2003 August 27; 290(8): 1033-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12941675&dopt=Abstract

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Estrogen replacement therapy and antidepressant response to sertraline in older depressed women. Author(s): Schneider LS, Small GW, Clary CM. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2001 Fall; 9(4): 393-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11739065&dopt=Abstract

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Exposure therapy and sertraline in social phobia: I-year follow-up of a randomised controlled trial. Author(s): Haug TT, Blomhoff S, Hellstrom K, Holme I, Humble M, Madsbu HP, Wold JE. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2003 April; 182: 312-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12668406&dopt=Abstract

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Gender, aggression and serotonergic function are associated with response to sertraline for behavioral disturbances in Alzheimer's disease. Author(s): Lanctot KL, Herrmann N, van Reekum R, Eryavec G, Naranjo CA. Source: International Journal of Geriatric Psychiatry. 2002 June; 17(6): 531-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12112177&dopt=Abstract

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Hyponatremia associated with sertraline and fluoxetine: a case report. Author(s): Raphael K, Tokeshi J. Source: Hawaii Med J. 2002 March; 61(3): 46-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11965835&dopt=Abstract

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Interaction of sertraline with Candida species selectively attenuates fungal virulence in vitro. Author(s): Lass-Florl C, Ledochowski M, Fuchs D, Speth C, Kacani L, Dierich MP, Fuchs A, Wurzner R. Source: Fems Immunology and Medical Microbiology. 2003 January 21; 35(1): 11-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12589952&dopt=Abstract

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Managing depression in brain injury rehabilitation: the use of an integrated care pathway and preliminary report of response to sertraline. Author(s): Turner-Stokes L, Hassan N, Pierce K, Clegg F. Source: Clinical Rehabilitation. 2002 May; 16(3): 261-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12017513&dopt=Abstract

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Mean dose after splitting sertraline tablets. Author(s): Matuschka PR, Graves JB. Source: The Journal of Clinical Psychiatry. 2001 October; 62(10): 826. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11816873&dopt=Abstract

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Obsessive compulsive disorder in huntington disease: a case of isolated obsessions successfully treated with sertraline. Author(s): Patzold T, Brune M. Source: Neuropsychiatry, Neuropsychology, and Behavioral Neurology. 2002 September; 15(3): 216-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12218715&dopt=Abstract

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Olanzapine-sertraline combination in schizophrenia with obsessive-compulsive disorder. Author(s): Poyurovsky M, Kurs R, Weizman A. Source: The Journal of Clinical Psychiatry. 2003 May; 64(5): 611. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12755669&dopt=Abstract

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Older community residents with depression: long-term treatment with sertraline. Randomised, double-blind, placebo-controlled study. Author(s): Wilson KC, Mottram PG, Ashworth L, Abou-Saleh MT. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2003 June; 182: 492-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12777339&dopt=Abstract

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Placebo-controlled trial of sertraline in the treatment of children with generalized anxiety disorder. Author(s): Rynn MA, Siqueland L, Rickels K. Source: The American Journal of Psychiatry. 2001 December; 158(12): 2008-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11729017&dopt=Abstract

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Platelet/endothelial biomarkers in depressed patients treated with the selective serotonin reuptake inhibitor sertraline after acute coronary events: the Sertraline AntiDepressant Heart Attack Randomized Trial (SADHART) Platelet Substudy. Author(s): Serebruany VL, Glassman AH, Malinin AI, Nemeroff CB, Musselman DL, van Zyl LT, Finkel MS, Krishnan KR, Gaffney M, Harrison W, Califf RM, O'Connor CM; Sertraline AntiDepressant Heart Attack Randomized Trial Study Group. Source: Circulation. 2003 August 26; 108(8): 939-44. Epub 2003 Aug 11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12912814&dopt=Abstract

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Posttraumatic stress disorder and quality of life: results across 64 weeks of sertraline treatment. Author(s): Rapaport MH, Endicott J, Clary CM. Source: The Journal of Clinical Psychiatry. 2002 January; 63(1): 59-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11838628&dopt=Abstract

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Probing the safety of medications in the frail elderly: evidence from a randomized clinical trial of sertraline and venlafaxine in depressed nursing home residents. Author(s): Oslin DW, Ten Have TR, Streim JE, Datto CJ, Weintraub D, DiFilippo S, Katz IR. Source: The Journal of Clinical Psychiatry. 2003 August; 64(8): 875-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12927001&dopt=Abstract

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Psychosocial outcomes following long-term, double-blind treatment of chronic depression with sertraline vs placebo. Author(s): Kocsis JH, Schatzberg A, Rush AJ, Klein DN, Howland R, Gniwesch L, Davis SM, Harrison W. Source: Archives of General Psychiatry. 2002 August; 59(8): 723-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12150648&dopt=Abstract

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Psychotic mania in bipolar II depression related to sertraline discontinuation. Author(s): Benazzi F. Source: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 2002 August; 47(6): 584-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12211891&dopt=Abstract

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Quetiapine augmentation of sertraline in obsessive-compulsive disorder. Author(s): Francobandiera G. Source: The Journal of Clinical Psychiatry. 2002 November; 63(11): 1046-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12469688&dopt=Abstract

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Rapid and sensitive determination of sertraline in human plasma using gas chromatography-mass spectrometry. Author(s): Kim KM, Jung BH, Choi MH, Woo JS, Paeng KJ, Chung BC. Source: Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences. 2002 April 5; 769(2): 333-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11996499&dopt=Abstract

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Review of sertraline in post-traumatic stress disorder. Author(s): Schwartz AC, Rothbaum BO. Source: Expert Opinion on Pharmacotherapy. 2002 October; 3(10): 1489-99. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12387695&dopt=Abstract

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Sertraline and fluoxetine treatment of obsessive-compulsive disorder: results of a double-blind, 6-month treatment study. Author(s): Bergeron R, Ravindran AV, Chaput Y, Goldner E, Swinson R, van Ameringen MA, Austin C, Hadrava V. Source: Journal of Clinical Psychopharmacology. 2002 April; 22(2): 148-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11910259&dopt=Abstract

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Sertraline and vaginal bleeding -- a possible association. Author(s): Smith M, Robinson D. Source: Journal of the American Geriatrics Society. 2002 January; 50(1): 200-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12028271&dopt=Abstract

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Sertraline and vaginal bleeding--a possible association? Author(s): Palmer TR. Source: Journal of the American Geriatrics Society. 2003 February; 51(2): 279. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12558732&dopt=Abstract

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Sertraline and/or interpersonal psychotherapy for patients with dysthymic disorder in primary care: 6-month comparison with longitudinal 2-year follow-up of effectiveness and costs. Author(s): Browne G, Steiner M, Roberts J, Gafni A, Byrne C, Dunn E, Bell B, Mills M, Chalklin L, Wallik D, Kraemer J. Source: Journal of Affective Disorders. 2002 April; 68(2-3): 317-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12063159&dopt=Abstract

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Sertraline as monotherapy in the treatment of psychotic and nonpsychotic depression. Author(s): Simpson GM, El Sheshai A, Rady A, Kingsbury SJ, Fayek M. Source: The Journal of Clinical Psychiatry. 2003 August; 64(8): 959-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12927014&dopt=Abstract

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Sertraline for treatment of depression in acute coronary syndromes. Author(s): Lesperance F, Frasure-Smith N. Source: Jama : the Journal of the American Medical Association. 2002 November 20; 288(19): 2403; Author Reply 2403-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12435245&dopt=Abstract

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Sertraline for treatment of depression in acute coronary syndromes. Author(s): Steinberg DI. Source: Jama : the Journal of the American Medical Association. 2002 November 20; 288(19): 2403; Author Reply 2403-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12435244&dopt=Abstract

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Sertraline hepatotoxicity: a case report and review of the literature on selective serotonin reuptake inhibitor hepatotoxicity. Author(s): Persky S, Reinus JF. Source: Digestive Diseases and Sciences. 2003 May; 48(5): 939-44. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12772794&dopt=Abstract

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Sertraline hydrochloride treatment for patients with hemodialysis hypotension. Author(s): Yalcin AU, Sahin G, Erol M, Bal C. Source: Blood Purification. 2002; 20(2): 150-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11818677&dopt=Abstract

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Sertraline in chronic tension-type headache. Author(s): Singh NN, Misra S. Source: J Assoc Physicians India. 2002 July; 50: 873-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12126338&dopt=Abstract

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Sertraline is more effective than imipramine in the treatment of non-melancholic depression: results from a multicentre, randomized study. Author(s): Baca E, Gonzalez de Chavez M, Garcia-Toro M, Perez-Arnau F, PorrasChavarino A. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2003 May; 27(3): 493-500. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12691786&dopt=Abstract

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Sertraline pharmacokinetics and dynamics in adolescents. Author(s): Axelson DA, Perel JM, Birmaher B, Rudolph GR, Nuss S, Bridge J, Brent DA. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 2002 September; 41(9): 1037-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12218424&dopt=Abstract

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Sertraline treatment of elderly patients with depression and cognitive impairment. Author(s): Devanand DP, Pelton GH, Marston K, Camacho Y, Roose SP, Stern Y, Sackeim HA. Source: International Journal of Geriatric Psychiatry. 2003 February; 18(2): 123-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12571820&dopt=Abstract

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Sertraline treatment of major depression in patients with acute MI or unstable angina. Author(s): Glassman AH, O'Connor CM, Califf RM, Swedberg K, Schwartz P, Bigger JT Jr, Krishnan KR, van Zyl LT, Swenson JR, Finkel MS, Landau C, Shapiro PA, Pepine CJ, Mardekian J, Harrison WM, Barton D, Mclvor M; Sertraline Antidepressant Heart Attack Randomized Trial (SADHEART) Group. Source: Jama : the Journal of the American Medical Association. 2002 August 14; 288(6): 701-9. Erratum In: Jama 2002 October 9; 288(14): 1720. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12169073&dopt=Abstract

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Sertraline treatment of obsessive-compulsive disorder: efficacy and tolerability of a rapid titration regimen. Author(s): Bogetto F, Albert U, Maina G. Source: European Neuropsychopharmacology : the Journal of the European College of Neuropsychopharmacology. 2002 June; 12(3): 181-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12007668&dopt=Abstract

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Sertraline versus imipramine treatment of comorbid panic disorder and major depressive disorder. Author(s): Lepola U, Arato M, Zhu Y, Austin C. Source: The Journal of Clinical Psychiatry. 2003 June; 64(6): 654-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12823079&dopt=Abstract

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Sertraline: a review of its use in the management of major depressive disorder in elderly patients. Author(s): Muijsers RB, Plosker GL, Noble S. Source: Drugs & Aging. 2002; 19(5): 377-92. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12093324&dopt=Abstract

•

Sertraline-induced akathisia and dystonia misinterpreted as a panic attack. Author(s): Walker L. Source: Psychiatric Services (Washington, D.C.). 2002 November; 53(11): 1477-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12407283&dopt=Abstract

•

Sertraline-induced hypoglycemia. Author(s): Pollak PT, Mukherjee SD, Fraser AD. Source: The Annals of Pharmacotherapy. 2001 November; 35(11): 1371-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11724085&dopt=Abstract

Studies 21

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Sertraline-related night sweats. Author(s): Ahmed A. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2002 July-August; 10(4): 484. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12095910&dopt=Abstract

•

Side effects after phototherapy implementation in addition to fluoxetine or sertraline treatment: a report of two cases. Author(s): Swiecicki L, Szafranski T. Source: World J Biol Psychiatry. 2002 April; 3(2): 109-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12479085&dopt=Abstract

•

Significant reduction of sertraline plasma levels by carbamazepine and phenytoin. Author(s): Pihlsgard M, Eliasson E. Source: European Journal of Clinical Pharmacology. 2002 February; 57(12): 915-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11936714&dopt=Abstract

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Similar effectiveness of paroxetine, fluoxetine, and sertraline in primary care: a randomized trial. Author(s): Kroenke K, West SL, Swindle R, Gilsenan A, Eckert GJ, Dolor R, Stang P, Zhou XH, Hays R, Weinberger M. Source: Jama : the Journal of the American Medical Association. 2001 December 19; 286(23): 2947-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11743835&dopt=Abstract

•

Simultaneous determination of viloxazine, venlafaxine, imipramine, desipramine, sertraline, and amoxapine in whole blood: comparison of two extraction/cleanup procedures for capillary gas chromatography with nitrogen-phosphorus detection. Author(s): Martinez MA, Sanchez de la Torre C, Almarza E. Source: Journal of Analytical Toxicology. 2002 July-August; 26(5): 296-302. Erratum In: J Anal Toxicol. 2003 March; 27(2): 8A. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12166817&dopt=Abstract

•

Spotlight on sertraline in the management of major depressive disorder in elderly patients. Author(s): Muijsers RB, Plosker GL, Noble S. Source: Cns Drugs. 2002; 16(11): 789-94. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12383038&dopt=Abstract

22 Zoloft

•

Switching patients from daily citalopram, paroxetine, or sertraline to once-weekly fluoxetine in the maintenance of response for depression. Author(s): Miner CM, Brown EB, Gonzales JS, Munir R. Source: The Journal of Clinical Psychiatry. 2002 March; 63(3): 232-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11926723&dopt=Abstract

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The antidepressant sertraline: a review of its uses in a range of psychiatric and medical conditions. Author(s): Khouzam HR, Emes R, Gill T, Raroque R. Source: Compr Ther. 2003 Spring; 29(1): 47-53. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12701343&dopt=Abstract

•

The clinical profile of older patients' response to antidepressants--an open trial of sertraline. Author(s): Mottram PG, Wilson KC, Ashworth L, Abou-Saleh M. Source: International Journal of Geriatric Psychiatry. 2002 June; 17(6): 574-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12112182&dopt=Abstract

•

The impact of sertraline on psychomotor performance. Author(s): Paul MA, Gray G, Lange M. Source: Aviation, Space, and Environmental Medicine. 2002 October; 73(10): 964-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12398257&dopt=Abstract

•

The pharmacokinetics of sertraline excretion into human breast milk: determinants of infant serum concentrations. Author(s): Stowe ZN, Hostetter AL, Owens MJ, Ritchie JC, Sternberg K, Cohen LS, Nemeroff CB. Source: The Journal of Clinical Psychiatry. 2003 January; 64(1): 73-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12590627&dopt=Abstract

•

The relationship of MRI subcortical hyperintensities to treatment response in a trial of sertraline in geriatric depressed outpatients. Author(s): Salloway S, Boyle PA, Correia S, Malloy PF, Cahn-Weiner DA, Schneider L, Krishnan KR, Nakra R. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2002 January-February; 10(1): 107-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11790641&dopt=Abstract

Studies 23

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Toxic optic neuropathy after concomitant use of melatonin, zoloft, and a high-protein diet. Author(s): Lehman NL, Johnson LN. Source: Journal of Neuro-Ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society. 1999 December; 19(4): 232-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10608673&dopt=Abstract

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Treating depression in Alzheimer disease: efficacy and safety of sertraline therapy, and the benefits of depression reduction: the DIADS. Author(s): Lyketsos CG, DelCampo L, Steinberg M, Miles Q, Steele CD, Munro C, Baker AS, Sheppard JM, Frangakis C, Brandt J, Rabins PV. Source: Archives of General Psychiatry. 2003 July; 60(7): 737-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12860778&dopt=Abstract

•

Treatment strategies in patients with major depression not responding to first-line sertraline treatment. A randomised study of extended duration of treatment, dose increase or mianserin augmentation. Author(s): Licht RW, Qvitzau S. Source: Psychopharmacology. 2002 May; 161(2): 143-51. Epub 2002 March 20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11981594&dopt=Abstract

25

CHAPTER 2. NUTRITION AND ZOLOFT Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and Zoloft.

Finding Nutrition Studies on Zoloft The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.4 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “Zoloft” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

4

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

26 Zoloft

The following information is typical of that found when using the “Full IBIDS Database” to search for “Zoloft” (or a synonym): •

Toxic optic neuropathy after concomitant use of melatonin, zoloft, and a high-protein diet. Author(s): Neuro-ophthalmology Unit, Mason Eye Institute, University of MissouriColumbia, USA. Source: Lehman, N L Johnson, L N J-Neuroophthalmol. 1999 December; 19(4): 232-4 1070-8022

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

•

The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

•

Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

Nutrition 27

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMD®Health: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html

The following is a specific Web list relating to Zoloft; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Minerals Chromium Source: Healthnotes, Inc. www.healthnotes.com Fluoxetine Source: Healthnotes, Inc. www.healthnotes.com Paroxetine Source: Healthnotes, Inc. www.healthnotes.com

29

CHAPTER 3. ALTERNATIVE MEDICINE AND ZOLOFT Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to Zoloft. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to Zoloft and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “Zoloft” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to Zoloft: •

A clinical plan for MDMA (Ecstasy) in the treatment of posttraumatic stress disorder (PTSD): partnering with the FDA. Author(s): Doblin R. Source: J Psychoactive Drugs. 2002 April-June; 34(2): 185-94. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12691208&dopt=Abstract

•

Bitterest pill? Author(s): Hampshire M. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 2000 October 11-17; 15(4): 14-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11971482&dopt=Abstract

•

Cerebral blood flow in obsessive-compulsive patients with major depression: effect of treatment with sertraline or desipramine on treatment responders and nonresponders.

30 Zoloft

Author(s): Hoehn-Saric R, Schlaepfer TE, Greenberg BD, McLeod DR, Pearlson GD, Wong SH. Source: Psychiatry Research. 2001 November 30; 108(2): 89-100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11738543&dopt=Abstract •

Chromium potentiation of antidepressant pharmacotherapy for dysthymic disorder in 5 patients. Author(s): McLeod MN, Gaynes BN, Golden RN. Source: The Journal of Clinical Psychiatry. 1999 April; 60(4): 237-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10221284&dopt=Abstract

•

Comparison of an extract of hypericum (LI 160) and sertraline in the treatment of depression: a double-blind, randomized pilot study. Author(s): Brenner R, Azbel V, Madhusoodanan S, Pawlowska M. Source: Clinical Therapeutics. 2000 April; 22(4): 411-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10823363&dopt=Abstract

•

Effect of Hypericum perforatum (St John's wort) in major depressive disorder: a randomized controlled trial. Author(s): Hypericum Depression Trial Study Group. Source: Jama : the Journal of the American Medical Association. 2002 April 10; 287(14): 1807-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11939866&dopt=Abstract

•

Effect of sertraline on regional metabolic rate in patients with affective disorder. Author(s): Buchsbaum MS, Wu J, Siegel BV, Hackett E, Trenary M, Abel L, Reynolds C. Source: Biological Psychiatry. 1997 January 1; 41(1): 15-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8988791&dopt=Abstract

•

Effects of standardized extracts of St. John's wort on the single-unit activity of serotonergic dorsal Raphe neurons in awake cats: comparisons with fluoxetine and sertraline. Author(s): Fornal CA, Metzler CW, Mirescu C, Stein SK, Jacobs BL. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 2001 December; 25(6): 858-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11750179&dopt=Abstract

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Efficacy of continuation treatment with hypericum perforatum in depression. Author(s): Brenner R, Madhusoodanan S, Pawlowska M. Source: The Journal of Clinical Psychiatry. 2002 May; 63(5): 455. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12019675&dopt=Abstract

Alternative Medicine 31

•

Further evidence of anticonvulsant role for 5-hydroxytryptamine in genetically epilepsy-prone rats. Author(s): Yan QS, Jobe PC, Dailey JW. Source: British Journal of Pharmacology. 1995 August; 115(7): 1314-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7582562&dopt=Abstract

•

Mania in a patient receiving testosterone replacement postorchidectomy taking St John's wort and sertraline. Author(s): Barbenel DM, Yusufi B, O'Shea D, Bench CJ. Source: Journal of Psychopharmacology (Oxford, England). 2000 March; 14(1): 84-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10757260&dopt=Abstract

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Pica and the obsessive-compulsive spectrum disorders. Author(s): Stein DJ, Bouwer C, van Heerden B. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1996 December; 86(12 Suppl): 1586-8, 1591-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9180801&dopt=Abstract

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Placebo in clinical trials for depression: complexity and necessity. Author(s): Kupfer DJ, Frank E. Source: Jama : the Journal of the American Medical Association. 2002 April 10; 287(14): 1853-4. Erratum In: Jama 2002 June 19; 287(23): 3083. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11939872&dopt=Abstract

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Prefrontal repetitive transcranial magnetic stimulation as add on treatment in depression. Author(s): Garcia-Toro M, Pascual-Leone A, Romera M, Gonzalez A, Mico J, Ibarra O, Arnillas H, Capllonch I, Mayol A, Tormos JM. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2001 October; 71(4): 546-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11561046&dopt=Abstract

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Regional cerebral blood flow in mood disorders, V.: Effects of antidepressant medication in late-life depression. Author(s): Nobler MS, Roose SP, Prohovnik I, Moeller JR, Louie J, Van Heertum RL, Sackeim HA. Source: The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2000 Fall; 8(4): 289-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11069268&dopt=Abstract

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Selections from current literature. Treatments for premenstrual dysphoric disorder. Author(s): Carr M.

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Source: Family Practice. 2001 December; 18(6): 644-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11739355&dopt=Abstract •

Serotonin uptake inhibitors modulate intracellular Ca2+ mobilization in platelets. Author(s): Helmeste DM, Tang SW, Reist C, Vu R. Source: European Journal of Pharmacology. 1995 February 15; 288(3): 373-7. Erratum In: Eur J Pharmacol 1995 July 18; 290(2): 173-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7774682&dopt=Abstract

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St John's wort or sertraline? Randomized controlled trial in primary care. Author(s): van Gurp G, Meterissian GB, Haiek LN, McCusker J, Bellavance F. Source: Can Fam Physician. 2002 May; 48: 905-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12053635&dopt=Abstract

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St. John's wort and hypomania. Author(s): Schneck C. Source: The Journal of Clinical Psychiatry. 1998 December; 59(12): 689. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9921706&dopt=Abstract

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The effects of grapefruit juice on sertraline metabolism: an in vitro and in vivo study. Author(s): Lee AJ, Chan WK, Harralson AF, Buffum J, Bui BC. Source: Clinical Therapeutics. 1999 November; 21(11): 1890-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10890261&dopt=Abstract

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The treatment of social phobia in general practice. is exposure therapy feasible? Author(s): Haug TT, Hellstrom K, Blomhoff S, Humble M, Madsbu HP, Wold JE. Source: Family Practice. 2000 April; 17(2): 114-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10758071&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

•

AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

•

Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com®: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

Alternative Medicine 33

•

Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMD®Health: http://my.webmd.com/drugs_and_herbs

•

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html

•

Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to Zoloft; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Depression Source: Healthnotes, Inc. www.healthnotes.com Depression Source: Integrative Medicine Communications; www.drkoop.com Eating Disorders Source: Healthnotes, Inc. www.healthnotes.com Fibromyalgia Source: Healthnotes, Inc. www.healthnotes.com Hypochondriasis Source: Integrative Medicine Communications; www.drkoop.com Post Traumatic Stress Disorder Source: Integrative Medicine Communications; www.drkoop.com PTSD Source: Integrative Medicine Communications; www.drkoop.com

•

Alternative Therapy Herbal Medicine Source: Integrative Medicine Communications; www.drkoop.com

•

Herbs and Supplements 5-HTP Source: Integrative Medicine Communications; www.drkoop.com

34 Zoloft

5-Hydroxytryptophan Source: Healthnotes, Inc. www.healthnotes.com 5-Hydroxytryptophan (5-HTP) Source: Integrative Medicine Communications; www.drkoop.com Antidepressants Source: Healthnotes, Inc. www.healthnotes.com Citalopram Source: Healthnotes, Inc. www.healthnotes.com Fluvoxamine Source: Healthnotes, Inc. www.healthnotes.com Ginkgo biloba Source: Healthnotes, Inc. www.healthnotes.com Sertraline Source: Healthnotes, Inc. www.healthnotes.com St. John's wort Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,824,00.html Tramadol Source: Healthnotes, Inc. www.healthnotes.com Tramadol Alternative names: Ultram Source: Prima Communications, Inc.www.personalhealthzone.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

35

CHAPTER 4. CLINICAL TRIALS AND ZOLOFT Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning Zoloft.

Recent Trials on Zoloft The following is a list of recent trials dedicated to Zoloft.5 Further information on a trial is available at the Web site indicated. •

Drug Therapy for Alcohol Dependence in Alaska Natives (naltrexone/sertraline) Condition(s): Alcoholism Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study will assess the ability of naltrexone (Revia) to reduce the risk of relapse in Alaska natives with alcohol dependence. The study will also examine whether a combination of naltrexone and sertraline (Zoloft) yields better abstinence rates than naltrexone used alone. Alaska Native individuals will be recruited into a 16 week outpatient study. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000451

•

Sertraline Compared With Hypericum Perforatum (St. John's Wort) in Treating Mild to Moderate Depression in Patients With Cancer Condition(s): Depression; unspecified adult solid tumor, protocol specific Study Status: This study is currently recruiting patients.

5

These are listed at www.ClinicalTrials.gov.

36 Zoloft

Sponsor(s): CCOP - Wake Forest University Research Base; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Antidepressants such as sertraline and the herb hypericum perforatum (St. John's wort) may be effective in treating mild to moderate depression. It is not yet known which treatment is more effective in improving depression in patients who have cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of sertraline with that of St. John's wort in treating mild to moderate depression in patients who have solid tumors. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00066859 •

Treatment of Cholestatic Pruritus With Sertraline Condition(s): Pruritus; Liver Cirrhosis, Biliary; Hepatitis C Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: The goal of this study is to find an effective and well-tolerated medical therapy for itching due to liver disease. Persons with primary biliary cirrhosis or chronic hepatitis C are currently being enrolled in the study. Persons participating in the study are given sertraline, a medication which is also often used for depression,to treat their itching. The dose is gradually increased as the effect on itching and any other potential side effects are carefully monitored. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00058903

•

CREST-II: Tiagabine, Sertraline, or Donepezil vs. Unmatched Placebo - 9 Condition(s): Cocaine-Related Disorders Study Status: This study is completed. Sponsor(s): National Institute on Drug Abuse (NIDA) Purpose - Excerpt: A clinical trial on the efficacy and safety of tiagabine, sertraline, or donepezil, for the treatment of cocaine dependence using a modified placebo-controlled experimental design Phase(s): Phase II Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00015132

•

Sertraline and Cognitive Therapy in Depressed Alcoholics Condition(s): Alcoholism; Depression

Clinical Trials 37

Study Status: This study is completed. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study will assess whether individuals treated with sertraline (Zoloft) and cognitive behavior therapy will experience improvement with their depression and consume less alcohol than individuals treated with a placebo and cognitive behavior therapy. This is a 12-week, random assignment, placebo-controlled, double-blind study with followup assessments 1 and 3 months after treatment. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000458 •

Sertraline and Naltrexone for Alcohol Dependence Condition(s): Alcoholism Study Status: This study is completed. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study is a double-blind, placebo-controlled outpatient trial to improve, through the addition of sertraline (Zoloft), the abstinence and relapse rates in alcohol- dependent individuals currently taking naltrexone (Revia). Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000440

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Sertraline for Alcohol Dependence and Depression Condition(s): Alcoholism; Depression Study Status: This study is completed. Sponsor(s): National Institute on Alcohol Abuse and Alcoholism (NIAAA) Purpose - Excerpt: This study will examine depressed alcoholic outpatients to assess whether combining naltrexone (Revia) and sertraline (Zoloft) will result in greater reductions in both drinking and depression over either medication alone or placebo. A secondary aim is to determine whether certain patient features will predict response to sertraline, naltrexone or the combination of the two drugs. Subjects will be randomized into treatment groups for 16 weeks. The followup phase includes two visits at 6 and 9 months after treatment. Phase(s): Phase IV Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00004554

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Sertraline for the Treatment of Patients with Frontal Lobe Dementia (FLD) Study Status: This study is completed.

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Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: Dementia refers to a condition where there is a loss of intellectual function (cognition). It is usually a progressive condition that interferes with normal social and occupational activities. Patients with frontal lobe dementia (FLD) suffer from a destruction of the brain cells found in the frontal lobe of the brain. Loss of frontal lobe neurons can cause changes in personality, such as aggressiveness, agitation, and depression. In addition, patients with FLD may have difficulty planning tasks and may have a loss of motivation. Researchers believe that the cells lost in the frontal lobe of the brain are responsible for producing a chemical called serotonin. Serotonin is a neurotransmitter, which means it is used by neurons to communicate with other neurons. Researchers are inclined to believe that by replacing the missing serotonin, symptoms of FLD may be relieved. Drugs known as serotonin uptake inhibitors, help to maintain high levels of serotonin in the body. They have been used successfully to treat patients with depression and patients with violent / impulsive behaviors. Sertraline is a serotonin reuptake blocker that is relatively easy to give (once daily), is safer than most other serotonin reuptake blockers (very little effect on vital enzyme systems [cytochrome P-450]), and has few interactions with other drugs. This study is designed to test the effectiveness of Sertaline for the treatment of symptoms associated with FLD. Patients participating in the study will receive Sertaline for 6 weeks and a placebo "inactive sugar pill" for 6 weeks. During the study, researchers will test psychological and neurological functions to measure the effects of the drug. Phase(s): Phase I; MEDLINEplus consumer health information Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001777

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “Zoloft” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 5. PATENTS ON ZOLOFT Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.6 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “Zoloft” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on Zoloft, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Zoloft By performing a patent search focusing on Zoloft, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We

6Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on Zoloft: •

Combined use of pramipexole and sertraline for the treatment of depression Inventor(s): Maj; Jerzy (Kracau, PL) Assignee(s): Boehringer Ingelheim Pharma KG (Ingelheim, DE) Patent Number: 6,255,329 Date filed: July 6, 1999 Abstract: The present invention relates to the use of 2-amino-4,5,6,7-tetrahydro-6-npropylamino-benzothiazole (pramipexole), the (+)- or (-)- enantiomer thereof, or one of the pharmacologically acceptable salts thereof, in conjunction with sertraline for the improved treatment of depression and depressive states. Excerpt(s): The present invention relates to an agent with an antidepressant activity containing 2-amino-4,5,6,7-tetrahydro-6-n-propylamino-benzothiazole, the (+) or (-) enantiomer thereof, the pharmacologically acceptable acid addition salts thereof and a conventional antidepressant. The combination of pramipexole and sertraline is of particular interest.... Pramipexole--(-)-2-amino-6-n-propylamino-4,5,6,7tetrahydrobenzo-thiazole-- is a dopamine-D.sub.3 /D.sub.2 agonist, the synthesis of which is described in European Patent 186 087 and U.S. Pat. No. 4,886,812. Pramipexole is known primarily for treating schizophrenia and particularly for the treatment of Parkinson's disease. German Patent Application DE 38 43 227 discloses that pramipexole lowers the prolactin serum level, and it is also known from German Patent Application DE 39 33 738 to use pramipexole to lower high TSH levels. Its transdermal administration is disclosed in U.S. Pat. No. 5,112,842, and WO Patent Application PCT/EP93/03389 describes the use of pramipexole as an antidepressant.... Details of the preparation of the title compound can be found in EP-A 85 116 016, and reference is hereby made specifically to the literature cited therein. Web site: http://www.delphion.com/details?pn=US06255329__

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Method of treating anxiety-related disorders using sertraline Inventor(s): Doogan; Declan P. (Canterbury, GB2), Hackett; Elizabeth (New York, NY), Scappaticci; Karen A. (New York, NY) Assignee(s): Pfizer Inc. (New York, NY) Patent Number: 4,962,128 Date filed: November 2, 1989 Abstract: A method of treating anxiety-related disorders comprising administering to a human in need of such treatment an amount of the compound (1S-cis)-4-(3,4dichlorophenyl)-1,2,3,4-tetrahydro-N-methyl-1-naphthalenam ine also known by the generic name sertraline, or a pharmaceutically acceptable salt thereof, effective in preventing or alleviating anxiety and the symptoms associated with anxiety-related disorders. Excerpt(s): This invention relates to a method of treating anxiety-related disorders such as panic disorder, generalized anxiety disorder, agoraphobia, simple phobias, social phobia, posttraumatic stress disorder, obsessive-compulsive disorder and avoidant

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personality disorder, using the compound (1S-cis)-4-(3,4-dichlorophenyl)-1,2,3,4tetrahydro-N-methyl-lnaphthalenami ne, hereinafter referred to by its generic name "sertraline", or a pharmaceutically acceptable salt thereof.... The present invention relates to a method of treating an anxiety-related disorder, comprising administering to a patient in need of such treatment an amount of sertraline, or a pharmaceutically acceptable salt thereof, effective in preventing or alleviating anxiety and the symptoms associated with such disorder. Examples of anxiety-related disorders that can be treated according to the method of this invention are panic disorder, generalized anxiety disorder, agoraphobia, simple phobias, social phobia, posttraumatic stress disorder, obsessive-compulsive disorder and avoidant personality disorder.... Examples of pharmaceutically acceptable salts of sertraline that can be used to treat anxiety-related disorders in accordance with the present invention are the acid addition salts of various mineral and organic acids such as hydrochloric, hydrobromic, hydroiodide, sulfuric, phosphoric, acetic, lactic, maleic, fumaric, citric, tartaric, succinic, and gluconic. Web site: http://www.delphion.com/details?pn=US04962128__ •

Method of treating chemical dependencies using sertraline Inventor(s): Norris; Evan R. (Chappaqua, NY), Koe; B. Kenneth (Ferry, CT), Bacopoulos; Nicholas G. (Stonington, CT), Blick; Peter A. (Los Gatos, CA) Assignee(s): Pfizer Inc. (New York, NY) Patent Number: 5,130,338 Date filed: February 28, 1991 Abstract: A method of treating a chemical dependency in a mammal, comprising administering to a mammal in need of such treatment an amount of the compound (1Scis)-4-(3, 4-dichlorophenyl)-1,2,3,4-tetraahydro-N-methyl-1-naphthalenamine, also known by the generic name sertraline, or a pharmaceutically acceptable salt thereof, effective in reducing or alleviating such dependency. Excerpt(s): This invention relates to a method of treating a chemical dependency in a mammal using the compound (1S-cis)-4-(3,4-dichlorophenyl)-1,2,3,4-tetrahydro-Nmethyl-lnaphthalenami ne, hereinafter referred to by its generic name "sertraline", or a pharmaceutically acceptable salt thereof.... The present invention relates to a method of treating a chemical dependency in a mammal, comprising administering to a mammal in need of such treatment an amount of sertraline, or a pharmaceutically acceptable salt thereof, effective in reducing or alleviating such dependency. "Chemical dependency," as used herein, means an abnormal craving or desire for, or an addiction to a drug. Such drugs are generally administered to the affected individual by any of a variety of means of administration, including oral, parenteral, nasal or by inhalation. Examples of chemical dependencies treatable by the method of the present invention are dependencies on alcohol, nicotine, cocaine, heroin, phenobarbitol, and benzodiazepines (e.g., Valium (trademark)). "Treating a chemical dependency," as used herein, means reducing or alleviating such dependency.... Examples of pharmaceutically acceptable salts of sertraline that can be used to treat chemical dependencies in accordance with the present invention are the acid addition salts of various mineral and organic acids such as hydrochloric, hydrobromic, hydroiodide, sulfuric, phosphoric, acetic, lactic, maleic, fumaric, citric, tartaric, succinic, and gluconic. Web site: http://www.delphion.com/details?pn=US05130338__

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Method of treating premature ejaculation using sertraline Inventor(s): Bick; Peter A. (Hartsdale, NY) Assignee(s): Pfizer Inc. (New York, NY) Patent Number: 4,940,731 Date filed: August 30, 1989 Abstract: A method of treating premature ejaculation comprising administering to a human in need of such treatment an amount of the compound (1S-cis)-4-(3,4dichlorophenyl)-1,2,3,4-tetrahydro-N-methyl-1-naphthalenam ine, also known by the generic name sertraline, or a pharmaceutically acceptable salt thereof, effective in delaying ejaculation. Excerpt(s): This invention relates to a method of treating premature ejaculation using the compound (1S-cis)-4-(3,4-dichlorophenyl)-1,2,3,4-tetrahydro-N-methyl-1-naphthalenam ine, hereinafter referred to by its generic name "sertraline", or a pharmaceutically acceptable salt thereof.... The present invention relates to a method of treating premature ejaculation, comprising administering to a patient in need of such treatment an amount of sertraline, or a pharmaceutically acceptable salt thereof, effective in delaying ejaculation.... Examples of pharmaceutically acceptable salts of sertraline that can be used to treat premature ejaculation in accordance with the present invention are the acid addition salts of various mineral and organic acids such as hydrochloric, hydrobromic, hydroiodide, sulfuric, phosphoric, acetic, lactic, maleic, fumaric, citric, tartaric, succinic, and gluconic. Web site: http://www.delphion.com/details?pn=US04940731__

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Methods for preparation of sertraline hydrochloride polymorphs Inventor(s): Nidam; Tamar (Yehud, IL), Schwartz; Eduard (Rechovot, IL), Liberman; Anita (Tel-Aviv, IL), Aronhime; Judith (Rehovot, IL), Singer; Claude (Kfar Saba, IL), Valdman; Evgeni (Petah Tikva, IL), Mendelovici; Marioara (Rechovot, IL) Assignee(s): Teva Pharmaceutical Industries Ltd. (Petah Tiqva, IL) Patent Number: 6,600,073 Date filed: June 5, 2000 Abstract: Novel methods for the preparation of sertraline hydrochloride Forms III, V, VI, VII, VII, IX and X are disclosed. According to the present invention, sertraline hydrochloride Form III may be produced by heating sertraline hydrochloride Forms V and VI. Sertraline hydrochloride Forms V and VI may be produced from either sertraline hydrochloride or sertraline base by crystallization. Sertraline hydrochloride Form VII may be produced by suspending sertraline chloride polymorph V in water, followed by filtration. Sertraline hydrochloride Forms VIII and IX may be produced by suspending sertraline base in water followed by acidification and filtration. Sertraline hydrochloride Form X may be produced by suspending sertraline hydrochloride in benzyl alcohol with heating, followed by filtration. Excerpt(s): The present invention relates to novel, reproducible methods for the preparation of crystalline forms of sertraline hydrochloride Forms III and V through X, as well as the preparation of an amorphous form of sertraline hydrochloride.... is approved, under the trademark Zoloft.RTM., by the U.S. Food and Drug Administration, for the treatment of depression, obsessive-compulsive disorder and

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panic disorder.... U.S. Pat. No. 4,536,518 ("the '518 patent") describes the preparation of sertraline hydrochloride with a melting point of 243-245.degree. C., by treating an ethyl acetate/ether solution of the free base with gaseous hydrogen chloride. The solid state properties of the sertraline hydrochloride so produced are not otherwise disclosed. Web site: http://www.delphion.com/details?pn=US06600073__ •

Process for converting stereoisomers of sertraline into sertraline Inventor(s): Chitturi; Trinadha Rao (Andhra Pradesh, IN), Jadav; Kanaksinh J. (Gujarat, IN), Thennati; Rajamannar (Tamil Nadu, IN) Assignee(s): Sun Pharmaceuticals Industries Ltd. (Mumbai, IN) Patent Number: 6,506,940 Date filed: November 10, 2000 Abstract: A process for converting the cis (1R, 4R), trans (1S, 4R), and trans (1R, 4S) stereoisomers of sertraline into sertraline comprises, starting with an initial reaction mixture which contains at least one of these stereoisomers, converting the sertraline stereoisomers into an imine form of sertraline. The imine form of sertraline is then reduced so that sertraline and at least one sertraline stereoisomer byproduct is produced in the reaction mixture. The sertraline is then recovered from the reaction mixture, e.g., by fractional crystallization (followed by resolution of sertraline from the cis (1R, 4R) stereoisomer, if necessary). The reaction mixture is then recycled through the same steps so that sertraline is produced from its stereoisomers in an asymptotic yield. Excerpt(s): These aforesaid isomers of formulas 2, 3 and 4 are undesired stereoisomers of sertraline of formula 1, and are invariably co-produced during the manufacture of this drug by known processes such as that disclosed in U.S. Pat. No. 4,536,518, which is incorporated herein by reference. More particularly, the present invention relates to a novel process for recycling the undesired stercoisomers, both the trans isomers as well as the cis (1R,4R) isomer, to obtain sertraline in asymptotic amounts through an iterative process. Sertraline hydrochloride (commonly known as Zoloft.RTM.) is an important drug useful in the treatment of depression, obsessive-compulsive disorder and panic disorder.... Sertraline has two chiral centres and hence has four stercoisomeric forms, namely, the (1R,4R), (1S,4S), (1R,4S), and (1S,4R) isomeric forms of setraline. Of these, the active stercoisomer for therapeutic purpose is the cis (1S,4S) isomer of formula 1.... The ketone is condensed with methylamine to form a racemic imine mixture of formula 5c (shown below). The racemic imine is then reduced by means of catalytic hydrogenation or by the use of a metal hydride complex to N-methyl-4-(3,4dichlorophenyl)-3,4-dihydro-1(2H)-naphthaleneamine, which is a racemic mixture of the cis and trans isomers. Trans isomers are separated from the cis isomers by fractional crystallization. Resolution of the separated cis racemate with optically active precipitant acid, such as D-(-)-mandelic acid in a classical manner, finally affords the desired cis(1S,4S)-enantiomer (sertraline). The process has the disadvantage that large amounts of the undesired isomers of formulas 2, 3, and 4 are co-produced thereby lowering the overall yield of sertraline and increasing the production cost. Web site: http://www.delphion.com/details?pn=US06506940__

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Process for preparation of pharmaceutically desired sertraline and sertraline analogs Inventor(s): Zinnen; Herman A. (Evanston, IL), Gattuso; Mark J. (Palatine, IL) Assignee(s): UOP LLC (Des Plaines, IL) Patent Number: 6,455,736 Date filed: November 3, 2000 Abstract: Improved processes for preparation of sertraline or sertraline analogs in high enantiomeric purity centers on resolution using simulated moving bed chromatography of isomeric racemic sertraline or sertraline analogs. Resolution is effected with high enantiomeric purity, and the undesired enantiomer may be racemized and recycled to the resolution phase to avoid loss. Excerpt(s): At the molecular level biological systems are highly asymmetric; enzymes, proteins, polysaccharides, nucleic acids, and many other fundamental components of life are present in optically active form. The implications of this are profound; as a general proposition the interaction of a chiral molecule with an optically active site is a diastereomeric interaction, and the two enantiomers properly should be viewed as distinct compounds capable of acting in different ways. (R)-Asparagine has a bitter taste, whereas the (S)-isomer is sweet. It has been known for some time that for medicinals having at least one chiral center the pharmacological effectiveness of the enantiomers of the racemic mixture may differ substantially, and in some cases the pharmacological action itself may differ. An extreme example is provided by propranolol, where the major pharmacological effect of the (R)-isomer is as a contraceptive, whereas the major pharmacological effect of the (S)-isomer is as a betablocker.... Although the recognition of the desirability of using the pharmacologically and pharmaceutically more acceptable enantiomer is old, nonetheless the use of optically pure medicinals generally is relatively new, simply because of the difficulty and cost of resolution of the racemic mixture and/or the difficulty and cost of asymmetric synthesis of the desired enantiomer. The importance of stereochemical purity may be exemplified by (S)-propranolol, which is known to be 100 times more potent as a beta-blocker than its (R)-enantiomer. Furthermore, optical purity is important since certain isomers actually may be deleterious rather than simply inert. For example, the R-enantiomer of thalidomide was a safe and effective sedative when prescribed for the control of morning sickness during pregnancy. However, Sthalidomide was discovered to be a potent teratogen leaving in its wake a multitude of infants deformed at birth.... Thus, there is described in U.S. Pat. Nos. 4,536,518, and 4,556,676 to W. M. Welch, Jr., as well as in the paper of W. M Welch, Jr. et. al., Journal of Medicinal Chemistry, Vol. 27, No. 11, p. 1508, (1984) a multi-step method for synthesizing pure cis-(1S)(4S)-N-methyl-4-(3,4-dichlorophenyl)-1,2,3,4-tetrahydro-1naphthal enamine. An important synthetic step involves reduction of a precursor immine to the corresponding amine, which reduction results in a mixture of the cis and trans isomers in the form of a racemate. This isomeric mixture is then separated by chromatography on silica gel or by fractional crystallization of the hydrochloride salts. The cis racemate amine free base is then classically resolved with an optically-selective precipitant acid, as is known in the art, to yield sertraline. Web site: http://www.delphion.com/details?pn=US06455736__

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Process for preparing (+)-cis-sertraline Inventor(s): Nidam; Tamar (Yehud, IL), Mendelovici; Marioara (Rechovot, IL), Pilarsky; Gideon (Holon, IL), Gershon; Neomi (Kfar Saba, IL) Assignee(s): Teva Pharmaceutical Industries Ltd. (Petah Tiqva, IL) Patent Number: 6,552,227 Date filed: March 14, 2001 Abstract: The present invention is directed to (+)-cis-sertraline hydrochloride and methods of preparation. The present invention also includes processes for making sertraline having a cis/trans ratio greater than 3:1, greater than or equal to 8:1, or between about 8:1 and about 12:1, from the Schiff base of sertralone, sertraline-1-imine. Excerpt(s): The present invention relates to the novel process of making and purifying (+)-cis-sertraline.... The imine, or Schiff base, is then reduced to sertraline. The reduction process of U.S. Pat. No. 4,536,518 comprises the hydrogenation of sertraline-1-imine concentrate at room temperature for two hours over 10% Pd/C catalyst in an atmosphere of hydrogen (1 atm pressure). The product is a racemic mixture of the cis and trans diastereomers ("(.+-.)-cis/trans-sertraline") in the ratio of approximately 3 to 1. This hydrogenation step can introduce a number of contaminants, including dechlorinated side-products, if not carefully controlled. One very problematic group of side products are dechlorinated-sertraline derivatives. It is desirable to have a hydrogenation method that reduces the amount of dechlorinated-sertraline side products or eliminates these side products.... The purification of cis-sertraline from (.+.)-cis/trans-sertraline as described in the '518 patent is relatively complicated and expensive requiring multiple recrystallizations, and the (.+-.)-cis/trans-sertraline so produced has a cis/trans ratios lower than 3:1. It is therefore desirable to have a method of initially making cis/trans-sertraline base from sertraline-1-imine with cis/trans ratios greater than 3:1. It is also desirable to have a simple and cost effective purification of (+)cis-sertraline from (.+-.)-cis/trans-sertraline base or from (.+-.)-cis/trans-sertraline hydrochloride. Web site: http://www.delphion.com/details?pn=US06552227__

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Process for preparing sertraline intermediates Inventor(s): Williams; Michael T. (Deal, GB2), Quallich; George J. (North Stonington, CT) Assignee(s): Pfizer, Inc. (New York, NY) Patent Number: 4,839,104 Date filed: June 16, 1988 Abstract: A novel three-step process for preparing 4-(3,4-dichlorophenyl)-4phenylbutanoic acid is disclosed, which involves (1) reducing 4-(3,4-dichlorophenyl)-4ketobutanoic acid to 4-(3,4-dichlorophenyl)-4-hydroxybutanoic acid; (2) then converting the intermediate hydroxy acid formed in the first step to 5-(3,4-dichlorophenyl)dihydro-2(3H)-furanone, and (3) thereafter reacting the resulting gamma-butyrolactone compound with benzene in a Friedel-Crafts type reaction to form the desired final product. The latter compound is known to be useful as an intermediate leading to 4-(3,4dichlorophenyl)-3,4-dihydro-1(2H)-naphthalenone and ultimately, to cis-(1S)(4S)-Nmethyl-4-(3,4-dichlorophenyl)-1,2,3,4-tetrahydro-1-naphthal ene amine (sertraline),

48 Zoloft

which is known to be a preferred anti-depressant agent in the field of medicinal chemistry. The aforementioned 5-(3,4-dichlorophenyl)-dihydro-2(3H)-furanone and 4(3,4-dichlorophenyl)-4-hydroxybutanoic acid are both novel compounds. There is also disclosed a novel process for converting 5-(3,4-dichlorophenyl)-dihydro-2(3H)-furanone directly to 4-(3,4-dichlorophenyl)-3,4-dihydro-1(2H)-naphthalenone, as well as an alternate novel process for converting 4-(3,4-dichlorophenyl)-4-hydroxybutanoic acid directly to this same key intermediate. Excerpt(s): This invention relates to a new and useful process for preparing a known 4,4diphenylbutanoic acid derivative. More particularly, it is concerned with a novel threestep process for preparing 4-(3,4-dichlorophenyl)-4-phenylbutanoic acid, which serves as a key intermediate in the production of the antidepressant agent known as cis(1S)(4S)-N-methyl-4-(3,4-dichlorophenyl)1,2,3,4-tetrahydro-1-naphthale neamine (sertraline) via 4-(3,4-dichlorophenyl)-3,4-dihydro-1(2H)-naphthalenone. The invention also includes within its scope such novel compounds as 4-(3,4-dichlorophenyl)-4hydroxybutanoic acid and 5-(3,4-dichlorophenyl)-dihydro-2(3H)-furanone, which are used as intermediates in the aforesaid three-step novel process. The invention additionally includes a novel process for converting both 4-(3,4-dichlorophenyl)-4hydroxybutanoic acid and 5-(3,4-dichlorophenyl)-dihydro-2(3H)-furanone directly to the aforesaid 4-(3,4-dichlorophenyl)-3,4-dihydro-1(2H)naphthalenone.... In accordance with the prior art, there is described in U.S. Pat. No. 4,536,518 to W. M. Welch, Jr. et al., as well as in the paper of W. M. Welch, Jr. et al. appearing in the Journal of Medicinal Chemistry, Vol. 27, No. 11, p. 1508 (1984), a method for preparing certain 4-(substituted phenyl)-4-(optionally-substituted phenyl)butanoic acids wherein the optional substituent is always other than alkoxy. These particular 4,4-diphenylbutanoic acid derivatives are shown to be useful as intermediates that lead to various antidepressant derivatives of cis-4-phenyl-1,2,3,4-tetrahydro-1-naphthaleneamine, including cis(1S)(4S)-N-methyl-4-(3,4-dichlorophenyl)-1,2,3,4-tetrahydronaphthalene amine (sertraline) which is an especially preferred embodiment in this series. The prior art method disclosed in the aforesaid publications of W. M. Welch, Jr. et. al. involves synthesizing the desired 4,4-diphenylbutanoic acid intermediates in a plurality of steps starting from the corresponding benzophenone compound. For instance, the appropriately substituted benzophenone starting material is first subjected to a basecatalyzed Stobbe condensation with diethyl succinate, followed by hydrolysis and decarboxylation with 48% aqueous hydrobromic acid to yield the corresponding 4,4diphenylbut-3-enoic acid, which is thereafter reduced by catalytic hydrogenation or by the use of hydriodic acid and red phosphorus to finally yield the desired 4,4diphenylbutanoic acid intermediate.... (c) thereafter reacting the resulting gammabutyrolactone compound formed in step (b) with benzene in an excess of said reagent as solvent or in a reaction-inert organic solvent in the presence of a FriedelCrafts type catalyst at a temperature of from about 0.degree. C. to 100.degree. C. until the alkylation of benzene by the aforesaid gamma-lactone compound of formula (III) to form the desired final product of formula (I) is substantially complete. Web site: http://www.delphion.com/details?pn=US04839104__

Patents 49

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Process for the production of enantiomerically pure or optically enriched sertralinetetralone using continuous chromatography Inventor(s): Zhang; Tong (Strasbourg, FR), Guinn; Robert M. (Mystic, CT), Quallich; George J. (North Stonington, CT), Geiser; Fiona (Glenn Mills, PA), Guhan; Subramanian S. (Niantic, CT), Dapremont; Oliver (Folsom, CA) Assignee(s): Chiral Technologies Europe (Illkirch Cedex, FR) Patent Number: 6,444,854 Date filed: May 1, 2001 Abstract: A process for the production of enantiomerically pure or optically enriched sertraline-tetralone from a mixture containing two enantiomers using continuous chuomatography. The chromatography comprises a liquid mobile phase comprising at least one polar solvent and a solid chiral stationary phase comprising a derivatized polysaccharide that is selected from amylosic, cellulosic, chitosan, xylan, curdlan, and inulan class of polysaccharide. Excerpt(s): This invention relates to the process for the production of enantiomerically pure or optically enriched sertraline-tetralone from a mixture containing two enantioners using continous chromatography or single column high performance chromatography. Some examples of continuous chromatography are liquid chromatography technologies know by the names cyclojet, and simulated moving bed chromatography (SMB). The concept of SMB was described in the late 1950's (U.S. Pat. Nos. 2,957,927 and 2,985,589) and has long been used in the petrochemical and sugar industries, Nicoud, R. M., LC-GC Intl. 5 (5), 43 (1992). Further reference can be made to U.S. Pat. Nos. 3,205,166; 3,291,726; and 3,310,486. A high efficiency continuous separation process using SMB is disclosed in U.S. Pat. Nos. 4,402,832; 5,518,625; 5,434,298: 5,434,299; 5,498,752; and Re 35,919 which are all incorporated by reference. In addition, "Chiral Discrimination on Polysacchride Derivatives", Yashima and Okamoto, Bull. Chem. Soc. Jpn., 68, 3289-3307(1995) discusses separation characteristics useful in chiral chromatography phases. Further discussion by Okamoto et. al. are included in The Journal of Chromatography, Part A, Volume 694, pp 101-109 (1995).... Sertralinetetralone is the starting raw material In the synthesis of Zoloft (sertraline hydrochloride), a drug currently marketed for the treatment of depression as disclosed in U.S. Pat. Nos. 4,536,518; 5,196,607; 5,442,116; and 4,777,288, all incorporated by reference. Current processes for preparing this compound as described in the above patents resolve the racemic mixture at a late stage. This late stage resolution requires the undesired enantiomer to be carried through several steps. A significant benefit is obtained if an enantiomerically pure sertaline-tetralone is used as the starting material.... A process for chromatographically resolving an enantiomerically pure or optically enriched sertraline-tetralone from a mixture containing two enantiomers uses continuous chromatography or single column high performance chromatography. The continuous chromatography comprses a liquid mobile phase comprising at least one polar solvent and a solid chiral stationary phase comprising a derivatized polysaccharide that is selected from the amylosic, cellulosic, chitosan, xylan, curdlan, dextran and inulan class of polysaccharides. Some examples of the continuous chromatography methods are the cyclojet process or simulated moving bed chromatography process. The simulated moving bed chromatography process is preferred. The process uses a chiral stationary phase which is a member of the amylosic or cellulosic class of polysaccharides selected from cellulose tribenzoate, cellulose tricinnamate, amylose tricinnamate, amylose tris[(S).alpha.-methyl benzyl carbamate], amylose 3,4-substituted phenyl carbamate and amylose 4-substituted phenyl-carbamate.

50 Zoloft

Preferably the chiral stationary phase is an analog of amylose (3,4-substituent phenyl carbamate) wherein the subsfituent is selected from 3-chloro-4-methyl, 3-methyl-4chloro or 3-fluoro-4-methyl. The chiral stationary phase can also preferably be a cellulose tricinnamate polysaccharide analog. The mobile phase comprises a solvent that is selected from heptane, hexane, isopropyl, ethanol, methanol. methyl acetate, acetonitrile, methyleno chloride, ethyl acetate and/or mixtures thereof. Preferably the mobile phase is selected from acetonitrile and/or a mixture of acetonitrile and methanol or ethanol and/or a mixture of ethanol and ethyl acetate. In one embodiment the chiral stationary phase is cellulose tricinnamate with a mobile phase of ethanol/ethyl acetate wherein the percentage of ethanol in the mobile phase mixture is greater than 50%. Preferably the chiral stationary phase is amylose (3-chloro-4-methylphenyl carbamate) and the mobile phase is acetonitrile/methanol wherein the percentage of acetonitrile in the mobile phase mixture is greater than 50%. The chromatographic retention times are increased or decreased by varying the mobile phase components. The separation affords at least one of the enantiomers a recovery of greater than or equal to 90 percent. The temperature range is about 5 to 45.degree. C., preferably 20 to 40.degree. C. The separation factor.alpha. is about 1.2 to 5.0. Using a temperature of about 40.degree. C. takes advantage of an increased solubility of sertratine tetralone in the mobile phase. The chiral stationary phase polysaccharide derivative can also be immobilized on silica gel, zirconium, alumina, ceramics and other silicas. Web site: http://www.delphion.com/details?pn=US06444854__ •

Sertraline hydrochloride Form II and methods for the preparation thereof Inventor(s): Aronhime; Judith (Rehovot, IL), Liberman; Anita (Tel-Aviv, IL), Nidam; Tamar (Yehud, IL), Schwartz; Eduard (Rechovot, IL), Mendelovici; Marioara (Rechovot, IL) Assignee(s): Teva Pharmaceutical Industries Ltd. (Petah Tiqva, IL) Patent Number: 6,495,721 Date filed: May 22, 2000 Abstract: The present invention is directed to Form II of sertraline hydrochloride and novel methods for its preparation. According to the present invention, sertraline hydrochloride Form II may be produced directly form sertraline base or sertraline mandelate. It may also be produced from sertraline hydrochloride solvate and hydrate forms, and crystallized from new solvent systems. Pharmaceutical compositions containing sertraline hydrochloride Form II and methods of treatment using such pharmaceutical compositions are also disclosed. Excerpt(s): The present invention relates to a novel crystalline form of sertraline hydrochloride, and reproducible methods for its preparation.... is approved, under the trademark Zoloft.RTM., by the U.S. Food and Drug Administration, for the treatment of depression, obsessive-compulsive disorder and panic disorder.... U.S. Pat. No. 4,536,518 ("the '518 patent") describes the preparation of sertraline hydrochloride with a melting point of 243-245.degree. C. by treating an ethyl acetate/ether solution of the free base with gaseous hydrogen chloride. The solid state properties of the sertraline hydrochloride so produced are not otherwise disclosed. Web site: http://www.delphion.com/details?pn=US06495721__

Patents 51

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Sertraline hydrochloride polymorphs Inventor(s): Mendelovici; Marioara (Rehovot, IL), Schwartz; Eduard (Rechovot, IL), Liberman; Anita (Tel-Aviv, IL), Aronhime; Judith (Rehovot, IL), Singer; Claude (Kfar Saba, IL), Valdman; Evgeni (Petah Tikva, IL), Nidam; Tamar (Yehud, IL) Assignee(s): Teva Pharmaceutical Industries Ltd. (Petah Tiqva, IL) Patent Number: 6,500,987 Date filed: November 24, 1999 Abstract: The present invention is directed to forms II, III, V, VI, VII, VIII, IX and X of sertraline hydrochloride and novel methods for their preparation. According to the present invention, sertraline hydrochloride polymorph II may be produced by slurrying sertraline hydrochloride polymorph VI in aprotic organic solvent. Sertraline hydrochloride polymorphic form III may be produced by heating sertraline hydrochloride polymorphs V and VI. Sertraline hydrochloride forms V and VI may be produced from either sertraline hydrochloride or sertraline base by crystallization. Sertraline hydrochloride Form VII may be produced by suspending sertraline chloride polymorph V in water, followed by filtration. Sertraline hydrochloride Forms VIII and IX may be produced by suspending sertraline base in water followed by acidification and filtration. Sertraline hydrochloride Form X may be produced by suspending sertraline hydrochloride in benzyl alcohol with heating, followed by filtration. Excerpt(s): The present invention relates to novel crystalline forms of sertraline hydrochloride, (1S-cis)-4-(3,4-dichlorophenyl)-1,2,3,4-tetrahydro-N-methyl1naphthalenaminehydrochloride, denominated Forms VI through X, an amorphous form and novel, reproducible methods for preparing them and for preparing previously reported polymorphs II, III and V.... is approved, under the trademark Zoloft.RTM., by the U.S. Food and Drug Administration, for the treatment of depression, obsessivecompulsive disorder and panic disorder.... U.S. Pat. No. 4,536,518 describes a synthesis of sertraline hydrochloride. U.S. Pat. No. 5,248,699 describes five crystalline forms of sertraline hydrochloride, designated Form I, Form II, Form III, Form IV and Form V. Web site: http://www.delphion.com/details?pn=US06500987__

•

Sertraline hydrochloride polymorphs, processes for preparing them, compositions containing them and methods of using them Inventor(s): Mendelovici; Marioara (Rehovot, IL), Nidam; Tamar (Yahud, IL), Aronhime; Judith (Rehovot, IL), Singer; Claude (Kfar Saba, IL) Assignee(s): Teva Pharmaceutical Industries Ltd. (Petah Tiqva, IL) Patent Number: 6,452,054 Date filed: December 21, 2000 Abstract: The present invention is directed to novel polymorphic Forms XI, XII, XIII, XIV, XV and XVI of sertraline hydrochloride, to processes for preparing them, methods of using them to treat disease, methods of using them to make other sertraline hydrochloride forms, and to pharmaceutical dosages containing the novel forms. Excerpt(s): The present invention relates to novel polymorphic Forms XI, XII, XIII, XIV, XV and XVI of sertraline hydrochloride, to processes for preparing them, methods of using them to treat disease, methods of using them to make other sertraline hydrochloride forms, and to pharmaceutical dosages containing the novel forms.... is

52 Zoloft

approved, under the trademark Zoloft.RTM., by the U.S. Food and Drug Administration, for the treatment of depression, obsessive-compulsive disorder and panic disorder.... U.S. Pat. No. 4,536,518 ("the '518 patent") describes the preparation of sertraline hydrochloride with a melting point of 243-245.degree. C. by treating an ethyl acetate/ether solution of the free base with gaseous hydrogen chloride. The solid state properties of the sertraline hydrochloride so produced are not otherwise disclosed. Web site: http://www.delphion.com/details?pn=US06452054__ •

Sertraline polymorph Inventor(s): Antczak; Casimir (Aurora, CA), Wilson; Andrew Joseph (Aurora, CA) Assignee(s): Torcan Chemical Ltd. (Aurora, CA) Patent Number: 5,734,083 Date filed: May 17, 1996 Abstract: A novel polymorph of sertraline hydrochloride, i.e. (1S-cis)-4-(3,4dichlorophenyl)-1,2,3,4-tetrahydro-N-methyl-1-naphthalenam ine hydrochloride, is disclosed, having improved water solubility along with acceptable stability. It is characterized by a unique x-ray diffraction pattern and unit cell structure, as well as IR and NMR spectral characteristics. Excerpt(s): This invention relates to the pharmaceutically active compound (1S-cis)-4(3,4-dichlorophenyl)-1,2,3,4-tetrahydro-N-methyl-1-naphthalenam ine, known and referred to herein by its generic name sertraline. More particularly, the invention relates to novel forms of sertraline, pharmaceutical compositions thereof and processes for the preparation thereof.... U.S. Pat. No. 4,536,518 Welch et al., issued Aug. 20, 1985, describes the synthesis and basic activities of the family of compounds including sertraline.... U.S. Pat. No. 5,248,699 Sysko et al., issued Sep. 28, 1993, discloses novel crystalline forms of sertraline hydrochloride, and reports five allegedly novel polymorphic forms, differing from one another in respect of their physical properties, stability, spectral data and methods of preparation. They are designated Form I, Form II, Form III, Form IV and Form V. Following the procedures disclosed in U.S. Pat. No. 4,536,518 is reported to lead to the preparation of the Form II product. The Form I product, however, is reported to have the greatest stability, and to be the most suitable for formulation. It is characterized, inter alia, by exhibiting an X-ray powder diffraction pattern with characteristic peaks expressed in degrees 2.theta. at approximately 7.1, 12.7, 14.1, 15.3, 15.7, 21.2, 23.4 and 26.3. It is prepared, according to this patent to Sysko et al., by crystallizing sertraline hydrochloride using an organic solvent such as ethyl acetate, over a period of about 3 hours at a temperature from about 20.degree. C. to about 100.degree. C. Web site: http://www.delphion.com/details?pn=US05734083__

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Sertraline salts and sustained-release dosage forms of sertraline Inventor(s): Friesen; Dwayne Thomas (Bend, OR), Am Ende; Mary Tanya (Griswold, CT), Curatolo; William John (Niantic, CT), Friedman; Hylar Lewis (Brattleboro, VT), Shankar; Ravi Mysore (Groton, CT), Herbig; Scott Max (East Lyme, CT), West; James Blair (Bend, OR) Assignee(s): Pfizer Inc. (New York, NY) Patent Number: 6,517,866 Date filed: September 7, 1999 Abstract: Sustained release dosage forms of sertraline which release sertraline at a rate between 1 mgA/hr and 40 mgA/hr. The dosage forms may exhibit an initial delay period during which sertraline is released at a rate less than 1 mgA/hr. Excerpt(s): Sertraline is most commonly prescribed for therapy of depressive illness, in the general dose range 50-200 mg/day. Sertraline has an elimination half-life of 23 hr, and is dosed once daily.... Patients are generally initiated on sertraline at a dose of 50 mg/day. Patients who do not respond at the 50 mg dose are given higher doses. Initiation at doses greater than 50 mg is generally avoided, when possible, because side effects such as dizziness, tremor, and sweating, and gastrointestinal upset are generally believed to be more severe at higher doses. If necessary to achieve efficacy, higher doses may be reached by slow titration up from lower doses. Improved sertraline dosage forms which exhibited a lower incidence and/or severity of side effects would be advantageous because (1) patient comfort would be improved, and (2) dosing could be initiated at doses higher than 50 mg. without the need for dose titration. Initiation at higher starting doses would, in turn, be useful by potentially effecting a shorter onset of antidepressive action. Thus, such an improved sertraline dosage form which permitted oral dosing of high doses of sertraline (e.g., 200 mg and higher) with relatively reduced side effects would permit wider therapeutic application of sertraline therapy, and would accordingly provide a significant improvement in dosing compliance and convenience. Likewise, an improved dosage form which lowered the incidence and/or severity of side-effects at lower doses would also be of significant value.... This invention provides an oral, sustained release dosage form of sertraline which decreases, relative to currently marketed instant release sertraline tablet dosage forms which deliver an equivalent bolus dose, the incidence and/or severity of gastrointestinal and/or other side effects such as dizziness, tremor and sweating. The dosage form operates by effecting the release of sertraline at a rate sufficiently slow to ameliorate side effects. Web site: http://www.delphion.com/details?pn=US06517866__

Patent Applications on Zoloft As of December 2000, U.S. patent applications are open to public viewing.7 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to Zoloft:

7

This has been a common practice outside the United States prior to December 2000.

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Encapsulated solution dosage forms of sertraline Inventor(s): Shanker, Ravi Mysore; (Groton, CT), Curatolo, William John; (Niantic, CT) Correspondence: PFIZER INC. PATENT DEPARTMENT, MS8260-1611; EASTERN POINT ROAD; GROTON; CT; 06340; US Patent Application Number: 20030133974 Date filed: December 5, 2002 Abstract: Dosage forms of sertraline encapsulated in a water-immiscible vehicle shorten T.sub.max and/or reduce side effects and/or decrease sertraline precipitation in chloride ion-containing use environments such as the gastrointestinal tract. Excerpt(s): This invention relates to an encapsulated solution dosage form of sertraline which exhibits, relative to conventional immediate-release dosage forms, a shorter time to reaching peak blood levels after oral dosing, and which also exhibits reduced side effects. The invention further relates to a method of treating psychiatric and other illnesses comprising administering sertraline in such a dosage form to a mammal, including a human patient, in need of such treatment.... Sertraline is a selective serotonin reuptake inhibitor (SSRI), which is useful as an antidepressant and anorectic agent, and in the treatment of obsessive-compulsive disorder, post-traumatic stress disorder, anxiety-related disorders and panic. Sertraline is also useful for the treatment of premature ejaculation, chemical dependencies, premenstrual dysphoric disorder, and obesity.... Sertraline is most commonly prescribed for therapy of depressive illness in the general dose range 50-200 mg/day. Sertraline has an elimination half-life of 23 hr, and is dosed once daily. The absolute oral bioavailability of sertraline dosed as Zoloft.RTM. tablets is 54%. Thus sertraline is a well-absorbed drug, and there is no motivation generally to try to improve the oral absorption of sertraline. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method for preparing sertraline Inventor(s): Laitinen, Ilpo; (Espoo, FI) Correspondence: OBLON SPIVAK MCCLELLAND MAIER & NEUSTADT PC; FOURTH FLOOR; 1755 JEFFERSON DAVIS HIGHWAY; ARLINGTON; VA; 22202; US Patent Application Number: 20030050509 Date filed: June 14, 2002 Abstract: (1S-cis)-4-(3,4-dichlorophenyl)-1,2,3,4-tetrahydro-N-methyl-1-naphthalenamine (sertraline) may be prepared by hydrogenating of N-[4-(3,4-dichlorophenyl)-3,4dihydro-1(2H)-naphthalenylidene]methanamine in the presence of a dehalogenation inhibitor, e.g., triphenylphosphite or trimethylphosphite and a catalyst. Excerpt(s): This application claims priority to U.S. Provisional Application Serial No. 60/298,088, which was filed on Jun. 15, 2001, and which is incorporated herein by reference in its entirety.... The present invention relates to a novel process for the preparation of (1S-cis)-4-(3,4-dichlorophenyl)-1,2,3,4-tetrahydro-N-methyl-1naphthalenamine(sertraline) comprising hydrogenation of N-[4-(3,4-dichlorophenyl)3,4-dihydro-1(2H)-naphthalenylidene]methanamine-.... is marketed in the form of its hydrochloride for the treatment of depression, obsessive-compulsive disorder and panic disorder.

Patents 55

Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Novel process for preparing (+)-cis-sertraline Inventor(s): Gershon, Neomi; (Kfar Saba, IL), Pilarsky, Gideon; (Holon, IL), Mendelovici, Marioara; (Rechovot, IL), Nidam, Tamar; (Yehud, IL) Correspondence: KENYON & KENYON; ONE BROADWAY; NEW YORK; NY; 10004; US Patent Application Number: 20030166970 Date filed: February 12, 2003 Abstract: The present invention is directed to (+)-cis-sertraline hydrochloride and methods of preparation. The present invention also includes processes for making sertraline having a cis/trans ratio greater than 3:1, greater than or equal to 8:1, or between about 8:1 and about 12:1, from the Schiff base of sertralone, sertraline-1-imine. Excerpt(s): This application claims the benefit of provisional application Serial No. 60/189,355, filed Mar. 14, 2000; which is incorporated herein by reference.... The present invention relates to the novel process of making and purifying (+)-cis-sertraline.... The imine, or Schiff base, is then reduced to sertraline. The reduction process of U.S. Pat. No. 4,536,518 comprises the hydrogenation of sertraline-1-imine concentrate at room temperature for two hours over 10% Pd/C catalyst in an atmosphere of hydrogen (1 atm pressure). The product is a racemic mixture of the cis and trans diastereomers ("(.+-.)cis/trans-sertraline") in the ratio of approximately 3 to 1. This hydrogenation step can introduce a number of contaminants, including dechlorinated side-products, if not carefully controlled. One very problematic group of side products are dechlorinatedsertraline derivatives. It is desirable to have a hydrogenation method that reduces the amount of dechlorinated-sertraline side products or eliminates these side products. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Novel sertraline hydrochloride polymorphs, processes compositions containing them and methods of using them

for

preparing

them,

Inventor(s): Singer, Claude; (Kfar Saba, IL), Nidam, Tamar; (Yahud, IL), Aronhime, Judith; (Rechovot, IL), Mendelovici, Marioara; (Rehovot, IL) Correspondence: KENYON & KENYON; ONE BROADWAY; NEW YORK; NY; 10004; US Patent Application Number: 20030023117 Date filed: September 13, 2002 Abstract: The present invention is directed to novel polymorphic Forms XI, XII, XIII, XIV, XV and XVI of sertraline hydrochloride, to processes for preparing them, methods of using them to treat disease, methods of using them to make other sertraline hydrochloride forms, and to pharmaceutical dosages containing the novel forms. Excerpt(s): This application claims the benefit of provisional applications serial No. 60/171,341, filed Dec. 21, 1999; No. 60/187,336, filed Mar. 6, 2000; No. 60/187,910, filed Mar. 8, 2000; and No. 60/190,603, filed Mar. 20, 2000. All four provisional applications are incorporated by reference. Co-pending commonly assigned U.S. application Ser. No. 09/448,985, filed Nov. 24, 1999, is incorporated herein by reference.... The present

56 Zoloft

invention relates to novel polymorphic Forms XI, XII, XIII, XIV, XV and XVI of sertraline hydrochloride, to processes for preparing them, methods of using them to treat disease, methods of using them to make other sertraline hydrochloride forms, and to pharmaceutical dosages containing the novel forms.... is approved, under the trademark Zoloft.RTM., by the U.S. Food and Drug Administration, for the treatment of depression, obsessive-compulsive disorder and panic disorder. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Process for the production of sertraline and intermediates useful therefor Inventor(s): Pietikaeinen, Pekka; (Espoo, FI), Laitinen, Ilpo; (Espoo, FI) Correspondence: OBLON SPIVAK MCCLELLAND MAIER & NEUSTADT PC; FOURTH FLOOR; 1755 JEFFERSON DAVIS HIGHWAY; ARLINGTON; VA; 22202; US Patent Application Number: 20030013768 Date filed: May 31, 2002 Abstract: A pharmaceutical intermediate, N-[4-(3,4-dichlorophenyl)-3,4-dihydro-1(2H)- naphthalenylidene]methanamine, which can be used in the production of sertraline hydrochloride, is conveniently prepared by reacting 4-(3,4-dichlorophenyl)-3,4-dihydro1-(2H)-naphthalenone with monomethylamine in a solvent which is an amide solvent with a structure of general formula IV: 1wherein R1, R3 are independently hydrogen or C.sub.1-6 alkyl, which can be substituted, and R2 is hydrogen. Excerpt(s): The present invention relates to a novel method for the production of sertraline. The present invention also relates to a novel process for the preparation of a pharmaceutical intermediate, N-[4-(3,4-dichlorophenyl)-3,4-dihydro-1 (2H)naphthalenylidene]methanamine, which is useful for the production of sertraline.... Sertraline is marketed in the form of its hydrochloride for the treatment of depression, obsessive-compulsive disorder and panic disorder.... with monomethylamine, which is catalyzed by titanium tetrachloride yielding N-[4-(3,4-dichlorophenyl)-3,4-dihydro1(2H)-naphthalenylidene]me- thanamine. The reaction is an equilibrium reaction, in which the equilibrium has to be shifted. This can be done, e.g., by using titanium tetrachloride to remove water from the reaction mixture. Titanium tetrachloride, however, is extremely reactive with water, and the side products formed are hazardous, and therefore other dehydrating agents have been considered. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Sertraline hydrochloride form II and methods for the preparation thereof Inventor(s): Nidam, Tamar; (Yehud, IL), Mendelovici, Marioara; (Rechovot, IL), Schwartz, Eduard; (Rechovot, IL), liberman, Anita; (Tel-Aviv, IL), Aronhime, Jodith; (Rehovot, IL) Correspondence: KENYON & KENYON; ONE BROADWAY; NEW YORK; NY; 10004; US Patent Application Number: 20020183555 Date filed: July 18, 2002 Abstract: The present invention is directed to Form II of sertraline hydrochloride and novel methods for its preparation. According to the present invention, sertraline

Patents 57

hydrochloride Form II may be produced directly form sertraline base or sertraline mandelate. It may also be produced from sertraline hydrochloride solvate and hydrate forms, and crystallized from new solvent systems. Pharmaceutical compositions containing sertraline hydrochloride Form II and methods of treatment using such pharmaceutical compositions are also disclosed. Excerpt(s): This application claims the benefit of provisional application Serial No. 60/182,159, filed Feb. 14, 2000; and is a continuation-in-part of application Ser. No. 09/448,985, filed Nov. 24, 1999, which claims the benefit of provisional application No. 60/147,888, filed Aug. 9, 1999. The contents of each of these applications are incorporated herein by reference.... The present invention relates to a novel crystalline form of sertraline hydrochloride, and reproducible methods for its preparation.... is approved, under the trademark Zoloft.RTM., by the U.S. Food and Drug Administration, for the treatment of depression, obsessive-compulsive disorder and panic disorder. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Sertraline hydrochloride polymorphs Inventor(s): Singer, Claude; (Kfar Saba, IL), Valdman, Evgeni; (Petah Tikva, IL), Liberman, Anita; (Tel-Aviv, IL), Schwartz, Eduard; (Rechovot, IL), Mendelovici, Marioara; (Rechovot, IL), Nidam, Tamar; (Yehud, IL), Aronhime, Judith; (Rehovot, IL) Correspondence: Steven J. Lee; KENYON & KENYON; One Broadway; New York; NY; 10004; US Patent Application Number: 20030055112 Date filed: August 13, 2002 Abstract: The present invention is directed to forms II, III, V, VI, VII, VIII, IX and X of sertraline hydrochloride and novel methods for their preparation. According to the present invention, sertraline hydrochloride polymorph II may be produced by slurrying sertraline hydrochloride polymorph VI in aprotic organic solvent. Sertraline hydrochloride polymorphic form III may be produced by heating sertraline hydrochloride polymorphs V and VI. Sertraline hydrochloride forms V and VI may be produced from either sertraline hydrochloride or sertraline base by crystallization. Sertraline hydrochloride Form VII may be produced by suspending sertraline chloride polymorph V in water, followed by filtration. Sertraline hydrochloride Forms VIII and IX may be produced by suspending sertraline base in water followed by acidification and filtration. Sertraline hydrochloride Form X may be produced by suspending sertraline hydrochloride in benzyl alcohol with heating, followed by filtration. Excerpt(s): The present invention relates to novel crystalline forms of sertraline hydrochloride, (1S-cis)-4-(3,4-dichlorophenyl)-1,2,3,4-tetrahydro-N-methyl-1naphthalenaminehydrochloride, denominated Forms VI through X, an amorphous form and novel, reproducible methods for preparing them and for preparing previously reported polymorphs II, III and V.... is approved, under the trademark Zoloft.RTM., by the U.S. Food and Drug Administration, for the treatment of depression, obsessivecompulsive disorder and panic disorder.... U.S. Pat. No. 4,536,518 describes a synthesis of sertraline hydrochloride. U.S. Pat. No. 5,248,699 describes five crystalline forms of sertraline hydrochloride, designated Form I, Form II, Form III, Form IV and Form V. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

58 Zoloft

•

SERTRALINE ORAL CONCENTRATE Inventor(s): HARPER, NANCY J. (GROTON, CT), WELCH, WILLARD M. (MYSTIC, CT), RANADE, GAUTAM R. (EAST LYME, CT) Correspondence: GREGG C BENSON; PFIZER INC; EASTERN POINT ROAD; GROTON; CT; 06340 Patent Application Number: 20030096868 Date filed: October 11, 1999 Abstract: The present invention provides an essentially nonaqueous, liquid pharmaceutical concentrate composition for oral administration containing sertraline or a pharmaceutically acceptable salt thereof and one or more pharmaceutically acceptable excipients. The present invention also provides a use of this concentrate composition to prepare an aqueous solution of sertraline. In addition, the present invention provides a method of using this concentrate composition to treat or prevent a variety of diseases or conditions. Finally, the present invention provides the compound, (1S-cis)-4-(3,4dichlorophenyl)-1,2,3,4-tetrahydro- -N-methyl-1-naphthalenamine methanesulfonate. Excerpt(s): The present invention provides an essentially nonaqueous, liquid pharmaceutical concentrate composition for oral administration containing sertraline or a pharmaceutically acceptable salt thereof and one or more pharmaceutically acceptable excipients. The present invention also provides a use of this concentrate composition to prepare an aqueous solution of sertraline. In addition, the present invention provides a method of using this concentrate composition to treat or prevent a variety of diseases or conditions. Finally, the present invention provides the compound, (1S-cis)-4-(3,4dichlorophenyl)-1,2,3,4-tetrahydro- -N-methyl-1-naphthalenamine methanesulfonate.... Sertraline has the following chemical name: (1S-cis)-4-(3,4-dichlor- ophenyl)-1,2,3,4tetrahydro-N-methyl-1-naphthalenamine. Sertraline and its pharmaceutically acceptable acid addition salts, such as the hydrochloride salt, are disclosed in U.S. Pat. No. 4,536,518, which issued on Aug. 20, 1985, (hereafter referred to as the '518 patent), which is herein incorporated by reference in its entirety. Another pharmaceutically acceptable salt of sertraline is the mesylate salt.... The '518 patent states that sertraline and derivatives thereof are useful as antidepressant agents. U.S. Pat. No. 5,130,338, which issued on Jul. 14, 1992, refers to the use of sertraline to treat chemical dependencies, including dependencies on alcohol, tobacco and cocaine. U.S. Pat. No. 4,962,128, which issued on Oct. 9, 1990, refers to the use of sertraline to treat anxiety related disorders such as panic disorder, obsessive-compulsive disorder, generalized anxiety disorder, phobias, post traumatic stress disorder and avoidant personality disorder. U.S. Pat. No. 4,940,731, which issued on Jul. 10, 1990, refers to the use of sertraline to treat premature ejaculation. Published PCT patent application, WO 96/22085, which was published on Jul. 25, 1996, refers to the use of sertraline to treat cancer patients. Published European patent application 0768083, which published on Apr. 16, 1997, refers to the use of sertraline to treat post myocardial infarction patients. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with Zoloft, you can access the U.S. Patent Office archive via the Internet at the following Web address:

Patents 59

http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “Zoloft” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on Zoloft. You can also use this procedure to view pending patent applications concerning Zoloft. Simply go back to the following Web address: http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON ZOLOFT Overview This chapter provides bibliographic book references relating to Zoloft. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on Zoloft include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print®). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “Zoloft” at online booksellers’ Web sites, you may discover nonmedical books that use the generic term “Zoloft” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “Zoloft” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Prozac and the New Antidepressants: What You Need to Know About Prozac, Zoloft, Paxil, Luvox, Wellbutrin, Effexor, Serzone, Vestra, Celexa, St. John's Wort, and Others by William S. Appleton (2000); ISBN: 0452281644; http://www.amazon.com/exec/obidos/ASIN/0452281644/icongroupinterna

•

Prozac Backlash: Overcoming the Dangers of Prozac, Zoloft, Paxil, and Other Antidepressants with Safe, Effective Alternatives by Joseph Glenmullen (Author) (2001); ISBN: 0743200624; http://www.amazon.com/exec/obidos/ASIN/0743200624/icongroupinterna

•

Prozac: Panacea or Pandora? the Rest of the Story on the New Class of Ssri Antidepressants Prozac, Zoloft, Paxil, Lovan, Luvox & More. by Chase Shephard (Illustrator), et al (1994); ISBN: 0916095592; http://www.amazon.com/exec/obidos/ASIN/0916095592/icongroupinterna

•

The Anti-Depressant Fact Book: What Your Doctor Won't Tell You About Prozac, Zoloft, Paxil, Celexa, and Luvox by Peter R. Breggin, M.D. Peter R. Breggin; ISBN:

62 Zoloft

073820451X; http://www.amazon.com/exec/obidos/ASIN/073820451X/icongroupinterna •

Zoloft, Paxil, Luvox and Prozac: All New Information to Help You Choose the Right Antidepressant by Donald L. Sullivan, Craig Williams (Introduction); ISBN: 0380795183; http://www.amazon.com/exec/obidos/ASIN/0380795183/icongroupinterna

Chapters on Zoloft In order to find chapters that specifically relate to Zoloft, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and Zoloft using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “Zoloft” (or synonyms) into the “For these words:” box.

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APPENDICES

65

APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute8: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

8

These publications are typically written by one or more of the various NIH Institutes.

66 Zoloft

•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

Physician Resources 67

NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.9 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:10 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

9

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 10 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway11 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.12 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “Zoloft” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 1175 3 1006 9 5 2198

HSTAT13 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.14 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.15 Simply search by “Zoloft” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

11

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

12

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 13 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 14 15

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

Physician Resources 69

Coffee Break: Tutorials for Biologists16 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.17 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.18 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

16 Adapted 17

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 18 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on Zoloft can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to Zoloft. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to Zoloft. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “Zoloft”:

72 Zoloft

•

Other guides Gallbladder and Bile Duct Diseases http://www.nlm.nih.gov/medlineplus/gallbladderandbileductdiseases.html Menstruation and Premenstrual Syndrome http://www.nlm.nih.gov/medlineplus/menstruationandpremenstrualsyndrome.h ml Mental Health http://www.nlm.nih.gov/medlineplus/mentalhealth.html Obsessive-Compulsive Disorder http://www.nlm.nih.gov/medlineplus/obsessivecompulsivedisorder.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to Zoloft. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources

A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMD®Health: http://my.webmd.com/health_topics

Patient Resources 73

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to Zoloft. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with Zoloft. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about Zoloft. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “Zoloft” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “Zoloft”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “Zoloft” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months.

74 Zoloft

The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “Zoloft” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.19

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

19

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

76 Zoloft

libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)20: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

20

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries 77

•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

78 Zoloft

•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries 79

•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

80 Zoloft

•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

81

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

83

ZOLOFT DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adrenergic Uptake Inhibitors: Drugs that block the transport of adrenergic transmitters into axon terminals or into storage vesicles within terminals. The tricyclic antidepressants (antidepressive agents, tricyclic) and amphetamines are among the therapeutically important drugs that may act via inhibition of adrenergic transport. Many of these drugs also block transport of serotonin. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerobic Exercise: A type of physical activity that includes walking, jogging, running, and dancing. Aerobic training improves the efficiency of the aerobic energy-producing systems that can improve cardiorespiratory endurance. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Aggressiveness: The quality of being aggressive (= characterized by aggression; militant; enterprising; spreading with vigour; chemically active; variable and adaptable). [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and

84 Zoloft

stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Agoraphobia: Obsessive, persistent, intense fear of open places. [NIH] Akathisia: 1. A condition of motor restlessness in which there is a feeling of muscular quivering, an urge to move about constantly, and an inability to sit still, a common extrapyramidal side effect of neuroleptic drugs. 2. An inability to sit down because of intense anxiety at the thought of doing so. [EU] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alkylation: The covalent bonding of an alkyl group to an organic compound. It can occur by a simple addition reaction or by substitution of another functional group. [NIH] Allylamine: Possesses an unusual and selective cytotoxicity for vascular smooth muscle cells in dogs and rats. Useful for experiments dealing with arterial injury, myocardial fibrosis or cardiac decompensation. [NIH] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amitriptyline: Tricyclic antidepressant with anticholinergic and sedative properties. It appears to prevent the re-uptake of norepinephrine and serotonin at nerve terminals, thus potentiating the action of these neurotransmitters. Amitriptyline also appears to antaganize cholinergic and alpha-1 adrenergic responses to bioactive amines. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amoxapine: The N-demethylated derivative of the antipsychotic agent loxapine that works by blocking the reuptake of norepinephrine, serotonin, or both. It also blocks dopamine receptors. [NIH] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics

Dictionary 85

and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Amylose: An unbranched glucan in starch. [NIH] Analgesics: Compounds capable of relieving pain without the loss of consciousness or without producing anesthesia. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidepressant: A drug used to treat depression. [NIH] Antipsychotic: Effective in the treatment of psychosis. Antipsychotic drugs (called also neuroleptic drugs and major tranquilizers) are a chemically diverse (including phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and diphenylbutylpiperidines) but pharmacologically similar class of drugs used to treat schizophrenic, paranoid, schizoaffective, and other psychotic disorders; acute delirium and dementia, and manic episodes (during induction of lithium therapy); to control the movement disorders associated with Huntington's chorea, Gilles de la Tourette's syndrome, and ballismus; and to treat intractable hiccups and severe nausea and vomiting. Antipsychotic agents bind to dopamine, histamine, muscarinic cholinergic, a-adrenergic, and serotonin receptors. Blockade of dopaminergic transmission in various areas is thought to be responsible for their major effects : antipsychotic action by blockade in the mesolimbic and mesocortical areas; extrapyramidal side effects (dystonia, akathisia, parkinsonism, and tardive dyskinesia) by blockade in the basal ganglia; and antiemetic effects by blockade in the chemoreceptor trigger zone of the medulla. Sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation) are caused by blockade of histamine, cholinergic, and adrenergic receptors. [EU] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH]

86 Zoloft

Anxiety Disorders: Disorders in which anxiety (persistent feelings of apprehension, tension, or uneasiness) is the predominant disturbance. [NIH] Aqueous: Having to do with water. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Barbiturate: A drug with sedative and hypnotic effects. Barbiturates have been used as sedatives and anesthetics, and they have been used to treat the convulsions associated with epilepsy. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Behavior Therapy: The application of modern theories of learning and conditioning in the treatment of behavior disorders. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Benzodiazepines: A two-ring heterocyclic compound consisting of a benzene ring fused to a diazepine ring. Permitted is any degree of hydrogenation, any substituents and any Hisomer. [NIH] Benzyl Alcohol: A colorless liquid with a sharp burning taste and slight odor. It is used as a local anesthetic and to reduce pain associated with lidocaine injection. Also, it is used in the manufacture of other benzyl compounds, as a pharmaceutic aid, and in perfumery and flavoring. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile duct: A tube through which bile passes in and out of the liver. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving

Dictionary 87

chemical reactions in living organisms. [EU] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bladder: The organ that stores urine. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Bulimia: Episodic binge eating. The episodes may be associated with the fear of not being able to stop eating, depressed mood, or self-deprecating thoughts (binge-eating disorder) and may frequently be terminated by self-induced vomiting (bulimia nervosa). [NIH] Bupropion: A unicyclic, aminoketone antidepressant. The mechanism of its therapeutic actions is not well understood, but it does appear to block dopamine uptake. The hydrochloride is available as an aid to smoking cessation treatment. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid;

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called also vas capillare. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbamazepine: An anticonvulsant used to control grand mal and psychomotor or focal seizures. Its mode of action is not fully understood, but some of its actions resemble those of phenytoin; although there is little chemical resemblance between the two compounds, their three-dimensional structure is similar. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardioselective: Having greater activity on heart tissue than on other tissue. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cellobiose: A disaccharide consisting of two glucose units in beta (1-4) glycosidic linkage. Obtained from the partial hydrolysis of cellulose. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebellar Diseases: Diseases that affect the structure or function of the cerebellum. Cardinal manifestations of cerebellar dysfunction include dysmetria, gait ataxia, and muscle hypotonia. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU]

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Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Cholinesterase Inhibitors: Drugs that inhibit cholinesterases. The neurotransmitter acetylcholine is rapidly hydrolyzed, and thereby inactivated, by cholinesterases. When cholinesterases are inhibited, the action of endogenously released acetylcholine at cholinergic synapses is potentiated. Cholinesterase inhibitors are widely used clinically for their potentiation of cholinergic inputs to the gastrointestinal tract and urinary bladder, the eye, and skeletal muscles; they are also used for their effects on the heart and the central nervous system. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Citalopram: A selective neuronal serotonin reuptake inhibitor and a clinically effective antidepressant with tolerable side effects. The drug is also effective in reducing ethanol uptake in alcoholics and is used in depressed patients who also suffer from tardive dyskinesia (TD) in preference to tricyclic antidepressants, which aggravate this condition. [NIH]

Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Clozapine: A tricylic dibenzodiazepine, classified as an atypical antipsychotic agent. It binds several types of central nervous system receptors, and displays a unique pharmacological profile. Clozapine is a serotonin antagonist, with strong binding to 5-HT 2A/2C receptor subtype. It also displays strong affinity to several dopaminergic receptors, but shows only weak antagonism at the dopamine D2 receptor, a receptor commonly thought to modulate neuroleptic activity. Agranulocytosis is a major adverse effect associated with administration of this agent. [NIH] Coal: A natural fuel formed by partial decomposition of vegetable matter under certain environmental conditions. [NIH] Coca: Any of several South American shrubs of the Erythroxylon genus (and family) that yield cocaine; the leaves are chewed with alum for CNS stimulation. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple

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mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Cognitive behavior therapy: A system of psychotherapy based on the premise that distorted or dysfunctional thinking, which influences a person's mood or behavior, is common to all psychosocial problems. The focus of therapy is to identify the distorted thinking and to replace it with more rational, adaptive thoughts and beliefs. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complete remission: The disappearance of all signs of cancer. Also called a complete response. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH]

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Compulsions: In psychology, an irresistible urge, sometimes amounting to obsession to perform a particular act which usually is carried out against the performer's will or better judgment. [NIH] Compulsive Behavior: The behavior of performing an act persistently and repetitively without it leading to reward or pleasure. The act is usually a small, circumscribed behavior, almost ritualistic, yet not pathologically disturbing. Examples of compulsive behavior include twirling of hair, checking something constantly, not wanting pennies in change, straightening tilted pictures, etc. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Conjugated: Acting or operating as if joined; simultaneous. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Crystallization: The formation of crystals; conversion to a crystalline form. [EU] Cytochrome: Any electron transfer hemoprotein having a mode of action in which the

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transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, ... New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Depersonalization: Alteration in the perception of the self so that the usual sense of one's own reality is lost, manifested in a sense of unreality or self-estrangement, in changes of body image, or in a feeling that one does not control his own actions and speech; seen in depersonalization disorder, schizophrenic disorders, and schizotypal personality disorder. Some do not draw a distinction between depersonalization and derealization, using depersonalization to include both. [EU] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [NIH] Derealization: Is characterized by the loss of the sense of reality concerning one's surroundings. [NIH] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH] Desipramine: A tricyclic dibenzazepine compound that potentiates neurotransmission. Desipramine selectively blocks reuptake of norepinephrine from the neural synapse, and also appears to impair serotonin transport. This compound also possesses minor anticholingeric activity, through its affinity to muscarinic receptors. [NIH] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The

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dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Donepezil: A drug used in the treatment of Alzheimer's disease. It belongs to the family of drugs called cholinesterase inhibitors. It is being studied as a treatment for side effects caused by radiation therapy to the brain. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dosage Forms: Completed forms of the pharmaceutical preparation in which prescribed doses of medication are included. They are designed to resist action by gastric fluids, prevent vomiting and nausea, reduce or alleviate the undesirable taste and smells associated with oral administration, achieve a high concentration of drug at target site, or produce a delayed or long-acting drug effect. They include capsules, liniments, ointments, pharmaceutical solutions, powders, tablets, etc. [NIH] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Dysphoric: A feeling of unpleasantness and discomfort. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Dystonia: Disordered tonicity of muscle. [EU] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Ejaculation: The release of semen through the penis during orgasm. [NIH] Encapsulated: Confined to a specific, localized area and surrounded by a thin layer of tissue. [NIH]

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Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endorphins: One of the three major groups of endogenous opioid peptides. They are large peptides derived from the pro-opiomelanocortin precursor. The known members of this group are alpha-, beta-, and gamma-endorphin. The term endorphin is also sometimes used to refer to all opioid peptides, but the narrower sense is used here; opioid peptides is used for the broader group. [NIH] Enkephalins: One of the three major families of endogenous opioid peptides. The enkephalins are pentapeptides that are widespread in the central and peripheral nervous systems and in the adrenal medulla. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estrogen: One of the two female sex hormones. [NIH] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Ether: One of a class of organic compounds in which any two organic radicals are attached directly to a single oxygen atom. [NIH] Excipients: Usually inert substances added to a prescription in order to provide suitable consistency to the dosage form; a binder, matrix, base or diluent in pills, tablets, creams, salves, etc. [NIH] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH]

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Fat: Total lipids including phospholipids. [NIH] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Flatus: Gas passed through the rectum. [NIH] Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants. [NIH] Frail Elderly: Older adults or aged individuals who are lacking in general strength and are unusually susceptible to disease or to other infirmity. [NIH] Frontal Lobe: The anterior part of the cerebral hemisphere. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gap Junctions: Connections between cells which allow passage of small molecules and electric current. Gap junctions were first described anatomically as regions of close apposition between cells with a narrow (1-2 nm) gap between cell membranes. The variety in the properties of gap junctions is reflected in the number of connexins, the family of proteins which form the junctions. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gasoline: Volative flammable fuel (liquid hydrocarbons) derived from crude petroleum by processes such as distillation reforming, polymerization, etc. [NIH] Gastric: Having to do with the stomach. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genital: Pertaining to the genitalia. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycoproteins: Conjugated protein-carbohydrate compounds including mucins, mucoid, and amyloid glycoproteins. [NIH]

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Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Education: Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Fairs: Community health education events focused on prevention of disease and promotion of health through audiovisual exhibits. [NIH] Heart Transplantation: The transference of a heart from one human or animal to another. [NIH]

Heartbeat: One complete contraction of the heart. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Hepatotoxicity: How much damage a medicine or other substance does to the liver. [NIH]

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Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Hydrobromic Acid: Hydrobromic acid (HBr). A solution of hydrogen bromide gas in water. [NIH]

Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogenation: Specific method of reduction in which hydrogen is added to a substance by the direct use of gaseous hydrogen. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hypericum: Genus of perennial plants in the family Clusiaceae (Hypericaceae). Herbal and homeopathic preparations are used for depression, neuralgias, and a variety of other conditions. Contains flavonoids, glycosides, mucilage, tannins, and volatile oils (oils, essential). [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthyroidism: Excessive functional activity of the thyroid gland. [NIH] Hypnotic: A drug that acts to induce sleep. [EU] Hypoglycemia: Abnormally low blood sugar [NIH] Hypomania: An abnormality of mood resembling mania (persistent elevated or expansive mood, hyperactivity, inflated self-esteem, etc.) but of lesser intensity. [EU] Hypotension: Abnormally low blood pressure. [NIH] Hypothyroidism: Deficiency of thyroid activity. In adults, it is most common in women and is characterized by decrease in basal metabolic rate, tiredness and lethargy, sensitivity to cold, and menstrual disturbances. If untreated, it progresses to full-blown myxoedema. In infants, severe hypothyroidism leads to cretinism. In juveniles, the manifestations are intermediate, with less severe mental and developmental retardation and only mild symptoms of the adult form. When due to pituitary deficiency of thyrotropin secretion it is called secondary hypothyroidism. [EU] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Imipramine: The prototypical tricyclic antidepressant. It has been used in major depression, dysthymia, bipolar depression, attention-deficit disorders, agoraphobia, and panic disorders. It has less sedative effect than some other members of this therapeutic group. [NIH]

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Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Impulsive Behavior: An act performed without delay, reflection, voluntary direction, or obvious control in response to a stimulus. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inhalation: The drawing of air or other substances into the lungs. [EU] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intracellular: Inside a cell. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intravenous: IV. Into a vein. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Isopropyl: A gene mutation inducer. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kinetic: Pertaining to or producing motion. [EU] Lactation: The period of the secretion of milk. [EU]

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Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Lipid: Fat. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Loxapine: An antipsychotic agent used in schizophrenia. [NIH] Luteal Phase: The period of the menstrual cycle that begins with ovulation and ends with menstruation. [NIH] Lutein Cells: The cells of the corpus luteum which are derived from the granulosa cells and the theca cells of the Graafian follicle. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Mania: Excitement of psychotic proportions manifested by mental and physical hyperactivity, disorganization of behaviour, and elevation of mood. [EU] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH]

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Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Methanol: A colorless, flammable liquid used in the manufacture of formaldehyde and acetic acid, in chemical synthesis, antifreeze, and as a solvent. Ingestion of methanol is toxic and may cause blindness. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU] Moclobemide: A reversible inhibitor of monoamine oxidase type A (RIMA) that has antidepressive properties. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monoamine: Enzyme that breaks down dopamine in the astrocytes and microglia. [NIH] Monoamine Oxidase: An enzyme that catalyzes the oxidative deamination of naturally occurring monoamines. It is a flavin-containing enzyme that is localized in mitochondrial membranes, whether in nerve terminals, the liver, or other organs. Monoamine oxidase is important in regulating the metabolic degradation of catecholamines and serotonin in neural or target tissues. Hepatic monoamine oxidase has a crucial defensive role in inactivating circulating monoamines or those, such as tyramine, that originate in the gut and are absorbed into the portal circulation. (From Goodman and Gilman's, The Pharmacological Basis of Therapeutics, 8th ed, p415) EC 1.4.3.4. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH]

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Monotherapy: A therapy which uses only one drug. [EU] Mood Disorders: Those disorders that have a disturbance in mood as their predominant feature. [NIH] Morphogenesis: The development of the form of an organ, part of the body, or organism. [NIH]

Motility: The ability to move spontaneously. [EU] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Motor Cortex: Area of the frontal lobe concerned with primary motor control. It lies anterior to the central sulcus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Muscle relaxant: An agent that specifically aids in reducing muscle tension, as those acting at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU] Muscle Relaxation: That phase of a muscle twitch during which a muscle returns to a resting position. [NIH] Muscle Spindles: Mechanoreceptors found between skeletal muscle fibers. Muscle spindles are arranged in parallel with muscle fibers and respond to the passive stretch of the muscle, but cease to discharge if the muscle contracts isotonically, thus signaling muscle length. The muscle spindles are the receptors responsible for the stretch or myotactic reflex. [NIH] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Myelin: The fatty substance that covers and protects nerves. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Naltrexone: Derivative of noroxymorphone that is the N-cyclopropylmethyl congener of naloxone. It is a narcotic antagonist that is effective orally, longer lasting and more potent than naloxone, and has been proposed for the treatment of heroin addiction. The FDA has approved naltrexone for the treatment of alcohol dependence. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training,

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health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neurosis: Functional derangement due to disorders of the nervous system which does not affect the psychic personality of the patient. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nonverbal Communication: Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the

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next. [NIH] Nystagmus: Rhythmical oscillation of the eyeballs, either pendular or jerky. [NIH] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Obsessive-Compulsive Disorder: An anxiety disorder characterized by recurrent, persistent obsessions or compulsions. Obsessions are the intrusive ideas, thoughts, or images that are experienced as senseless or repugnant. Compulsions are repetitive and seemingly purposeful behavior which the individual generally recognizes as senseless and from which the individual does not derive pleasure although it may provide a release from tension. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Orgasm: The crisis of sexual excitement in either humans or animals. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Overdose: An accidental or deliberate dose of a medication or street drug that is in excess of what is normally used. [NIH] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Panic Disorder: A type of anxiety disorder characterized by unexpected panic attacks that last minutes or, rarely, hours. Panic attacks begin with intense apprehension, fear or terror and, often, a feeling of impending doom. Symptoms experienced during a panic attack include dyspnea or sensations of being smothered; dizziness, loss of balance or faintness;

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choking sensations; palpitations or accelerated heart rate; shakiness; sweating; nausea or other form of abdominal distress; depersonalization or derealization; paresthesias; hot flashes or chills; chest discomfort or pain; fear of dying and fear of not being in control of oneself or going crazy. Agoraphobia may also develop. Similar to other anxiety disorders, it may be inherited as an autosomal dominant trait. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Paresthesias: Abnormal touch sensations, such as burning or prickling, that occur without an outside stimulus. [NIH] Paroxetine: A serotonin uptake inhibitor that is effective in the treatment of depression. [NIH]

Partial remission: The shrinking, but not complete disappearance, of a tumor in response to therapy. Also called partial response. [NIH] Parturition: The act or process of given birth to a child. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perennial: Lasting through the year of for several years. [EU] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Personality Disorders: A major deviation from normal patterns of behavior. [NIH] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmaceutical Solutions: Homogeneous liquid preparations that contain one or more chemical substances dissolved, i.e., molecularly dispersed, in a suitable solvent or mixture of mutually miscible solvents. For reasons of their ingredients, method of preparation, or use, they do not fall into another group of products. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharmacotherapy: A regimen of using appetite suppressant medications to manage obesity by decreasing appetite or increasing the feeling of satiety. These medications decrease appetite by increasing serotonin or catecholamine—two brain chemicals that affect mood

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and appetite. [NIH] Phenyl: Ingredient used in cold and flu remedies. [NIH] Phenytoin: An anticonvulsant that is used in a wide variety of seizures. It is also an antiarrhythmic and a muscle relaxant. The mechanism of therapeutic action is not clear, although several cellular actions have been described including effects on ion channels, active transport, and general membrane stabilization. The mechanism of its muscle relaxant effect appears to involve a reduction in the sensitivity of muscle spindles to stretch. Phenytoin has been proposed for several other therapeutic uses, but its use has been limited by its many adverse effects and interactions with other drugs. [NIH] Phobia: A persistent, irrational, intense fear of a specific object, activity, or situation (the phobic stimulus), fear that is recognized as being excessive or unreasonable by the individual himself. When a phobia is a significant source of distress or interferes with social functioning, it is considered a mental disorder; phobic disorder (or neurosis). In DSM III phobic disorders are subclassified as agoraphobia, social phobias, and simple phobias. Used as a word termination denoting irrational fear of or aversion to the subject indicated by the stem to which it is affixed. [EU] Phobic Disorders: Anxiety disorders in which the essential feature is persistent and irrational fear of a specific object, activity, or situation that the individual feels compelled to avoid. The individual recognizes the fear as excessive or unreasonable. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phototherapy: Treatment of disease by exposure to light, especially by variously concentrated light rays or specific wavelengths. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Pilot study: The initial study examining a new method or treatment. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Post-traumatic: Occurring as a result of or after injury. [EU]

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Post-traumatic stress disorder: A psychological disorder that develops in some individuals after a major traumatic experience such as war, rape, domestic violence, or accident. [NIH] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiating: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precipitation: The act or process of precipitating. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Premenstrual: Occurring before menstruation. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Primary Biliary Cirrhosis: A chronic liver disease. Slowly destroys the bile ducts in the liver. This prevents release of bile. Long-term irritation of the liver may cause scarring and cirrhosis in later stages of the disease. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prolactin: Pituitary lactogenic hormone. A polypeptide hormone with a molecular weight of about 23,000. It is essential in the induction of lactation in mammals at parturition and is synergistic with estrogen. The hormone also brings about the release of progesterone from lutein cells, which renders the uterine mucosa suited for the embedding of the ovum should fertilization occur. [NIH] Prone: Having the front portion of the body downwards. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Propranolol: A widely used non-cardioselective beta-adrenergic antagonist. Propranolol is used in the treatment or prevention of many disorders including acute myocardial infarction, arrhythmias, angina pectoris, hypertension, hypertensive emergencies, hyperthyroidism, migraine, pheochromocytoma, menopause, and anxiety. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH]

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Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Psychomotor Performance: The coordination of a sensory or ideational (cognitive) process and a motor activity. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Purifying: Respiratory equipment whose function is to remove contaminants from otherwise wholesome air. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Racemic: Optically inactive but resolvable in the way of all racemic compounds. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that

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the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Rape: Unlawful sexual intercourse without consent of the victim. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Resolving: The ability of the eye or of a lens to make small objects that are close together, separately visible; thus revealing the structure of an object. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the

Dictionary 109

personality. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serotonin Uptake Inhibitors: Compounds that specifically inhibit the reuptake of serotonin in the brain. This increases the serotonin concentration in the synaptic cleft which then activates serotonin receptors to a greater extent. These agents have been used in treatment of depression, panic disorder, obsessive-compulsive behavior, and alcoholism, as analgesics, and to treat obesity and bulimia. Many of the adrenergic uptake inhibitors also inhibit serotonin uptake; they are not included here. [NIH] Sertraline: A selective serotonin uptake inhibitor that is used in the treatment of depression. [NIH]

Sertraline Hydrochloride: Selective serotonin uptake inhibitor. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Smoking Cessation: Discontinuation of the habit of smoking, the inhaling and exhaling of tobacco smoke. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH]

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Social Security: Government sponsored social insurance programs. [NIH] Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Stabilization: The creation of a stable state. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH]

Dictionary 111

Sudden cardiac death: Cardiac arrest caused by an irregular heartbeat. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synapsis: The pairing between homologous chromosomes of maternal and paternal origin during the prophase of meiosis, leading to the formation of gametes. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Synaptic Vesicles: Membrane-bound compartments which contain transmitter molecules. Synaptic vesicles are concentrated at presynaptic terminals. They actively sequester transmitter molecules from the cytoplasm. In at least some synapses, transmitter release occurs by fusion of these vesicles with the presynaptic membrane, followed by exocytosis of their contents. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Tardive: Marked by lateness, late; said of a disease in which the characteristic lesion is late in appearing. [EU] Teratogen: A substance which, through immediate, prolonged or repeated contact with the skin may involve a risk of subsequent non-hereditable birth defects in offspring. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Thalidomide: A pharmaceutical agent originally introduced as a non-barbiturate hypnotic, but withdrawn from the market because of its known tetratogenic effects. It has been reintroduced and used for a number of immunological and inflammatory disorders. Thalidomide displays immunosuppresive and anti-angiogenic activity. It inhibits release of tumor necrosis factor alpha from monocytes, and modulates other cytokine action. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH]

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Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Thyroid Hormones: Hormones secreted by the thyroid gland. [NIH] Thyrotropin: A peptide hormone secreted by the anterior pituitary. It promotes the growth of the thyroid gland and stimulates the synthesis of thyroid hormones and the release of thyroxine by the thyroid gland. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tonicity: The normal state of muscular tension. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Tremor: Cyclical movement of a body part that can represent either a physiologic process or a manifestation of disease. Intention or action tremor, a common manifestation of cerebellar diseases, is aggravated by movement. In contrast, resting tremor is maximal when there is no attempt at voluntary movement, and occurs as a relatively frequent manifestation of Parkinson disease. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond

Dictionary 113

to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] VE: The total volume of gas either inspired or expired in one minute. [NIH] Venlafaxine: An antidepressant drug that is being evaluated for the treatment of hot flashes in women who have breast cancer. [NIH] Venous: Of or pertaining to the veins. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viloxazine: A morpholine derivative used as an antidepressant. It is similar in action to imipramine. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Vulva: The external female genital organs, including the clitoris, vaginal lips, and the opening to the vagina. [NIH] War: Hostile conflict between organized groups of people. [NIH] Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Zoloft: Selective serotonin uptake inhibitor. [NIH]

114

INDEX A Abdominal, 83, 107 Acetylcholine, 83, 89, 105 Adenosine, 83, 108 Adrenal Cortex, 83, 92, 110 Adrenergic, 83, 84, 85, 94, 95, 110, 114, 115 Adrenergic Uptake Inhibitors, 83, 114 Adverse Effect, 83, 90, 108, 114 Aerobic, 4, 83 Aerobic Exercise, 4, 83 Affinity, 83, 90, 93 Aggressiveness, 38, 83 Agonist, 42, 83, 94, 104, 105 Agoraphobia, 43, 84, 99, 107, 108 Akathisia, 22, 84, 85 Alimentary, 84, 100, 107 Alkaloid, 84, 90, 105 Alkylation, 49, 84 Allylamine, 84 Alpha-1, 84 Alternative medicine, 84 Amine, 47, 48, 84 Amino acid, 84, 97, 107, 110, 113, 115, 117, 118 Amitriptyline, 8, 84 Ammonia, 84 Amoxapine, 23, 84 Amphetamine, 84 Amylose, 50, 85 Analgesics, 85, 113 Analog, 50, 85 Anatomical, 85, 89, 100, 113 Angina, 21, 85, 110 Angina Pectoris, 85, 110 Anions, 85, 101 Anorexia, 85 Antagonism, 85, 90 Antibacterial, 85, 114 Antibiotic, 85, 114 Anticholinergic, 84, 85 Anticonvulsant, 31, 85, 88, 108 Antidepressant, 3, 7, 10, 13, 15, 21, 23, 30, 31, 42, 48, 54, 59, 62, 84, 85, 88, 90, 96, 99, 118 Antipsychotic, 84, 85, 90, 101, 105 Anxiety, 12, 15, 17, 42, 54, 59, 84, 85, 86, 106, 107, 108, 110 Anxiety Disorders, 86, 107 Aqueous, 49, 58, 86, 101 Arterial, 84, 86, 99, 110 Arteries, 86, 87, 92, 103, 104

Arterioles, 86, 87, 88 Atypical, 86, 90 Autoimmune disease, 86, 104 Autonomic, 14, 83, 85, 86, 105, 108 B Bacteria, 85, 86, 114, 118 Bactericidal, 86, 95 Barbiturate, 86, 116 Base, 36, 44, 45, 47, 48, 51, 52, 55, 57, 58, 86, 96, 97, 101 Behavior Therapy, 11, 37, 86 Benign, 86, 97 Benzene, 48, 49, 86 Benzodiazepines, 43, 86 Benzyl Alcohol, 45, 51, 58, 86 Bile, 72, 86, 87, 96, 101, 110, 115 Bile duct, 87, 110 Bioavailability, 54, 87 Biochemical, 87, 113 Biomarkers, 17, 87 Biotransformation, 87 Bladder, 87, 89, 91, 104, 110 Blood Platelets, 87, 113 Blood pressure, 87, 99 Blood vessel, 87, 88, 89, 102, 115, 116, 118 Body Fluids, 87, 117 Bolus, 54, 87 Bolus infusion, 87 Bone Marrow, 86, 87, 101, 102, 103, 114 Bowel, 87, 94 Bowel Movement, 87, 94 Branch, 79, 87, 102, 107, 114 Breakdown, 5, 88, 94, 96 Bulimia, 88, 113 Bupropion, 10, 12, 88 C Capillary, 23, 88, 118 Capsules, 88, 94 Carbamazepine, 22, 88 Carbohydrate, 88, 97, 109 Carbon Dioxide, 6, 88, 93, 112 Carcinogenic, 86, 88, 115 Cardiac, 14, 84, 88, 95, 96, 101, 104, 115 Cardiorespiratory, 4, 83, 88 Cardioselective, 88, 110 Cardiovascular, 7, 85, 88, 113 Case report, 16, 20, 88 Catecholamine, 88, 94, 108 Cations, 88, 101

Index 115

Cell, 6, 52, 84, 86, 88, 91, 93, 95, 96, 100, 102, 105, 106, 109, 110, 112, 116, 117, 118 Cellobiose, 89 Cellulose, 50, 89, 109 Central Nervous System, 83, 84, 86, 89, 90, 97, 103, 113 Central Nervous System Infections, 89, 97 Cerebellar, 89, 117 Cerebellar Diseases, 89, 117 Cerebral, 29, 31, 89, 92, 95, 96, 111 Cerebrum, 89 Chin, 89, 102 Cholinergic, 84, 85, 89, 105 Cholinesterase Inhibitors, 89, 94 Chronic, 8, 10, 13, 18, 20, 36, 89, 100, 110, 115 Cirrhosis, 36, 89, 110 CIS, 42, 43, 44, 45, 46, 47, 48, 51, 52, 53, 55, 58, 89 Citalopram, 23, 34, 90 Clinical Medicine, 90, 110 Clinical trial, 4, 31, 35, 36, 38, 67, 90, 92, 94, 110, 111, 112 Clozapine, 11, 90 Coal, 86, 90 Coca, 90 Cocaine, 7, 36, 43, 59, 90 Cofactor, 90, 110 Cognition, 38, 90, 105 Cognitive behavior therapy, 37, 90 Collapse, 88, 90 Complement, 91 Complementary and alternative medicine, 29, 34, 91 Complementary medicine, 29, 91 Complete remission, 91, 112 Compliance, 14, 54, 91 Compulsions, 91, 106 Compulsive Behavior, 91, 113 Computational Biology, 67, 91 Concomitant, 6, 24, 26, 92 Conjugated, 92, 93, 97 Connective Tissue, 5, 87, 92, 93, 113 Connective Tissue Cells, 92 Consciousness, 85, 92, 93 Contraindications, ii, 92 Controlled study, 8, 9, 15, 17, 92 Convulsions, 85, 86, 92 Coordination, 92, 103, 111 Coronary, 17, 19, 20, 85, 92, 103, 104 Coronary Thrombosis, 92, 103, 104 Cortisol, 14, 92 Cranial, 92, 97, 108 Craniocerebral Trauma, 92, 97 Crystallization, 44, 45, 46, 47, 51, 58, 92

Cytochrome, 12, 38, 92 Cytokine, 93, 116 D Decarboxylation, 49, 93 Degenerative, 93, 98 Delivery of Health Care, 93, 98 Dementia, 8, 37, 38, 85, 93 Dendrites, 93, 105 Depersonalization, 93, 107 Depressive Disorder, 9, 15, 21, 23, 30, 93 Derealization, 93, 107 Dermis, 93, 117 Desipramine, 23, 29, 93 Deuterium, 93, 99 Diagnostic procedure, 41, 94 Dialyzer, 94, 98 Digestion, 84, 86, 87, 94, 101, 115 Digestive system, 39, 94 Direct, iii, 90, 94, 99, 112, 115 Disinfectant, 94, 95 Dizziness, 53, 94, 107 Donepezil, 36, 94 Dopamine, 42, 84, 85, 88, 90, 94, 103, 105 Dorsal, 30, 94, 109 Dosage Forms, 53, 54, 94 Double-blind, 8, 9, 13, 15, 17, 18, 19, 30, 37, 94 Dyskinesia, 85, 90, 95 Dysphoric, 14, 31, 54, 93, 95 Dyspnea, 95, 107 Dystonia, 22, 85, 95 E Efficacy, 4, 8, 9, 13, 14, 15, 21, 24, 30, 36, 53, 95 Ejaculation, 44, 54, 59, 95, 113 Encapsulated, 54, 95 Endogenous, 6, 94, 95 Endorphins, 95, 105 Enkephalins, 95, 105 Environmental Health, 66, 68, 95 Enzyme, 12, 38, 95, 103, 118 Epinephrine, 83, 94, 95, 105, 118 Esophagus, 94, 95, 115 Estrogen, 15, 95, 110 Ethanol, 50, 90, 95 Ether, 45, 51, 52, 95 Excipients, 58, 96 Excitability, 12, 96 Excitation, 96, 105 Exogenous, 87, 95, 96 Extracellular, 92, 96 Extracellular Matrix, 92, 96 Extraction, 6, 23, 96 Extrapyramidal, 84, 85, 94, 96

116 Zoloft

F Family Planning, 67, 96 Fat, 87, 96, 101, 104, 113 Filtration, 44, 51, 58, 96 Flatus, 96 Fluoxetine, 7, 9, 10, 12, 13, 16, 19, 22, 23, 27, 30, 96 Frail Elderly, 18, 96 Frontal Lobe, 37, 38, 96, 103 G Gallbladder, 72, 83, 94, 96 Gap Junctions, 96, 116 Gas, 10, 18, 23, 84, 88, 96, 99, 105, 115, 118 Gasoline, 86, 96 Gastric, 14, 94, 96 Gastrointestinal, 14, 53, 54, 89, 95, 97, 113, 115, 117 Gastrointestinal tract, 54, 89, 95, 97, 113, 117 Gene, 97, 101 Genetic Code, 97, 106 Genital, 97, 118 Gland, 83, 97, 107, 110, 113, 115, 116, 117 Glucose, 89, 97 Glutamic Acid, 97, 105 Glycine, 84, 97, 105 Glycoproteins, 97, 100 Governing Board, 97, 109 Growth, 85, 97, 109, 116, 117 H Half-Life, 53, 54, 97 Headache, 20, 97 Headache Disorders, 97 Health Care Costs, 13, 98 Health Education, 98 Health Expenditures, 98 Health Fairs, 5, 98 Heart Transplantation, 12, 98 Heartbeat, 98, 115 Heme, 93, 98 Hemodialysis, 14, 20, 94, 98 Hemorrhage, 92, 97, 98, 115 Hemostasis, 98, 113 Hepatitis, 36, 98 Hepatocytes, 98 Hepatotoxicity, 20, 98 Heredity, 97, 98 Homologous, 98, 115, 116 Hormone, 92, 95, 98, 110, 113, 116, 117 Host, 99, 118 Hydrobromic Acid, 49, 99 Hydrogen, 45, 47, 51, 52, 55, 56, 84, 86, 88, 93, 99, 103, 106, 111 Hydrogenation, 45, 47, 49, 55, 86, 99 Hydrolysis, 48, 87, 89, 99

Hypericum, 30, 35, 36, 99 Hypersensitivity, 99, 113 Hypertension, 97, 99, 110 Hyperthyroidism, 99, 110 Hypnotic, 86, 99, 116 Hypoglycemia, 22, 99 Hypomania, 32, 99 Hypotension, 14, 20, 85, 92, 99 Hypothyroidism, 14, 99 I Id, 26, 32, 72, 78, 80, 99 Imipramine, 7, 10, 13, 20, 21, 23, 99, 118 Impairment, 21, 95, 100, 102 Impulsive Behavior, 38, 100 In vitro, 16, 32, 100 In vivo, 32, 100 Indicative, 61, 100, 107 Induction, 85, 100, 110 Infarction, 100 Infection, 100, 101, 105, 113 Inhalation, 43, 100 Inotropic, 94, 100 Insomnia, 9, 100 Insulator, 100, 104 Intermittent, 14, 100 Intestines, 83, 97, 100 Intracellular, 32, 100, 112 Intramuscular, 100, 107 Intravenous, 100, 107 Ion Channels, 5, 100, 108, 116 Ions, 5, 86, 99, 101 Isopropyl, 50, 101 K Kb, 66, 101 Kinetic, 101 L Lactation, 101, 110 Large Intestine, 94, 100, 101, 112 Lens, 101, 112 Lethargy, 99, 101 Library Services, 78, 101 Lidocaine, 86, 101 Ligaments, 92, 101 Lipid, 101, 104 Liver, 36, 83, 86, 87, 89, 94, 96, 98, 101, 103, 110 Lobe, 38, 101 Localized, 95, 100, 101, 103, 109 Locomotion, 6, 101, 109 Loxapine, 84, 101 Luteal Phase, 14, 101 Lutein Cells, 101, 110 Lymphatic, 100, 101, 114 Lymphatic system, 101, 114

Index 117

M Mania, 18, 31, 99, 102 Mediate, 94, 102 Mediator, 102, 113 MEDLINE, 68, 102 Meiosis, 102, 115, 116 Membrane, 91, 94, 96, 100, 102, 103, 108, 116 Memory, 85, 93, 102 Menopause, 102, 110 Menstrual Cycle, 101, 102, 110 Menstruation, 72, 101, 102, 110 Mental, iv, 4, 7, 16, 17, 39, 66, 68, 72, 89, 90, 93, 99, 102, 108, 111, 113 Mental Disorders, 39, 102, 111 Metabolite, 10, 87, 102 Methanol, 6, 50, 102 MI, 21, 81, 102 Mobilization, 32, 103 Moclobemide, 10, 103 Modification, 84, 103, 111 Molecular, 6, 7, 46, 67, 69, 92, 103, 110, 112, 117, 118 Molecule, 46, 86, 91, 96, 99, 103, 107, 112 Monoamine, 85, 103 Monoamine Oxidase, 85, 103 Monocytes, 103, 116 Monotherapy, 19, 103 Mood Disorders, 31, 103 Morphogenesis, 5, 103 Motility, 14, 103, 113 Motor Activity, 92, 103, 111 Motor Cortex, 12, 103 Mucosa, 103, 110 Multiple sclerosis, 11, 103 Muscle relaxant, 104, 108 Muscle Relaxation, 104 Muscle Spindles, 104, 108 Musculature, 5, 104 Myelin, 104 Myocardial infarction, 59, 92, 102, 104, 110 Myocardium, 85, 102, 104 N Naloxone, 104 Naltrexone, 8, 35, 37, 104 Narcotic, 104 Nausea, 85, 94, 104, 107 NCI, 1, 36, 38, 65, 90, 104 Need, 3, 42, 43, 44, 53, 54, 61, 62, 73, 83, 104 Neonatal, 10, 105 Nerve, 5, 7, 83, 84, 89, 93, 102, 103, 104, 105, 109, 113, 115, 117 Nervous System, 85, 89, 102, 105, 108, 115, 116 Neural, 93, 103, 105

Neuroleptic, 84, 85, 90, 105 Neuronal, 90, 105 Neurons, 30, 38, 90, 93, 104, 105, 115, 116 Neuropathy, 24, 26, 105 Neurosis, 105, 108 Neurotransmitter, 6, 7, 38, 83, 84, 89, 94, 97, 100, 105, 115, 116 Nicotine, 43, 105 Nitrogen, 23, 84, 105, 117 Nonverbal Communication, 105, 111 Norepinephrine, 83, 84, 93, 94, 105 Nucleic acid, 46, 97, 105, 106 Nystagmus, 10, 106 O Observational study, 9, 106 Obsessive-Compulsive Disorder, 15, 17, 18, 19, 21, 43, 45, 51, 52, 54, 55, 56, 57, 58, 59, 72, 106 Ointments, 94, 106 Ophthalmology, 24, 26, 106 Opiate, 8, 104, 106 Opium, 106 Orgasm, 95, 106 Outpatient, 35, 37, 106 Overdose, 9, 12, 106 Ovulation, 101, 106 Ovum, 106, 110 Oxidation, 87, 93, 106 P Pancreas, 83, 87, 94, 107, 117 Panic, 12, 13, 21, 22, 42, 45, 51, 52, 54, 55, 56, 57, 58, 59, 99, 107, 113 Panic Disorder, 12, 13, 21, 42, 45, 51, 52, 55, 56, 57, 58, 59, 99, 107, 113 Parenteral, 43, 107 Paresthesias, 107 Paroxetine, 9, 10, 11, 12, 13, 22, 23, 27, 107 Partial remission, 107, 112 Parturition, 107, 110 Patch, 107, 117 Pathologic, 92, 99, 107 Penis, 95, 107 Peptide, 84, 107, 110, 117 Perennial, 99, 107 Peripheral Nervous System, 95, 105, 108, 115 Personality Disorders, 10, 108 Pharmaceutical Preparations, 89, 95, 108 Pharmaceutical Solutions, 94, 108 Pharmacokinetic, 108 Pharmacologic, 4, 97, 108, 117 Pharmacotherapy, 9, 11, 12, 18, 22, 30, 108 Phenyl, 48, 50, 108 Phenytoin, 22, 88, 108 Phobia, 16, 32, 43, 108

118 Zoloft

Phobic Disorders, 108 Phosphorus, 23, 49, 108 Phototherapy, 22, 109 Physiologic, 84, 97, 102, 109, 112, 117 Pilot study, 13, 30, 109 Plants, 84, 88, 90, 97, 99, 106, 109 Plasma, 11, 14, 18, 22, 98, 109, 113 Platelets, 32, 109, 116 Pneumonia, 92, 109 Polymorphic, 51, 52, 53, 56, 58, 109 Polysaccharide, 49, 50, 89, 109 Posterior, 94, 107, 109 Postsynaptic, 109, 116 Post-traumatic, 10, 18, 54, 97, 109 Post-traumatic stress disorder, 10, 18, 54, 109 Potentiates, 93, 109 Potentiating, 84, 109 Potentiation, 30, 89, 109 Practice Guidelines, 68, 109 Precipitation, 54, 109 Precursor, 47, 94, 95, 105, 109, 117, 118 Premenstrual, 14, 31, 54, 72, 110 Presynaptic, 105, 110, 116 Primary Biliary Cirrhosis, 36, 110 Progesterone, 110, 115 Progressive, 38, 89, 93, 97, 110 Prolactin, 14, 42, 110 Prone, 31, 110 Prophase, 110, 115, 116 Propranolol, 46, 110 Prostate, 87, 110, 117 Protein S, 97, 110 Proteins, 46, 84, 91, 96, 103, 105, 107, 109, 110, 112, 114 Protocol, 5, 35, 110 Protons, 99, 111 Psychiatric, 9, 13, 22, 23, 54, 102, 111 Psychiatry, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 30, 31, 32, 111 Psychic, 102, 105, 111, 113 Psychomotor, 11, 23, 88, 105, 111 Psychomotor Performance, 23, 111 Psychotherapy, 11, 19, 90, 111 Public Policy, 67, 111 Purifying, 47, 55, 111 Q Quality of Life, 17, 111 R Race, 45, 46, 47, 49, 55, 111 Racemic, 45, 46, 47, 49, 55, 111 Radiation, 85, 94, 111, 118 Radiation therapy, 94, 111 Radioactive, 97, 99, 111

Randomized, 4, 9, 15, 17, 18, 20, 21, 22, 30, 32, 36, 37, 95, 111, 112 Randomized clinical trial, 18, 111 Randomized Controlled Trials, 15, 112 Rape, 109, 112 Reagent, 49, 112 Receptor, 7, 90, 94, 112, 113 Receptors, Serotonin, 112, 113 Rectum, 87, 94, 96, 101, 110, 112 Refer, 1, 91, 94, 95, 101, 105, 112 Refraction, 112, 114 Regimen, 21, 95, 108, 112 Relapse, 4, 15, 35, 37, 112 Remission, 13, 112 Resolving, 50, 112 Respiration, 88, 112 Rheumatism, 113 Rheumatoid, 11, 113 Rheumatoid arthritis, 11, 113 S Salivary, 94, 113 Salivary glands, 94, 113 Schizophrenia, 8, 13, 17, 42, 101, 113 Sclerosis, 104, 113 Screening, 90, 113 Secretion, 99, 101, 113 Secretory, 113, 116 Sedative, 7, 46, 84, 86, 99, 113 Seizures, 88, 108, 113 Semen, 95, 110, 113 Serotonin Uptake Inhibitors, 38, 113 Sertraline Hydrochloride, 14, 44, 45, 47, 49, 50, 51, 52, 53, 55, 56, 57, 58, 114 Serum, 24, 42, 91, 114, 117 Sex Characteristics, 114, 116 Side effect, 7, 10, 22, 36, 53, 54, 83, 84, 85, 90, 94, 114, 117 Signs and Symptoms, 112, 114 Smoking Cessation, 88, 114 Social Environment, 111, 114 Social Security, 112, 114 Solid tumor, 35, 36, 114 Solvent, 49, 50, 51, 53, 56, 57, 58, 86, 95, 102, 108, 114 Spatial disorientation, 94, 114 Specialist, 73, 114 Species, 16, 95, 102, 111, 114, 115, 118 Spectrum, 31, 114 Spinal cord, 89, 105, 108, 114 Stabilization, 108, 114 Steroid, 92, 115 Stimulus, 96, 100, 107, 108, 115, 116 Stomach, 83, 94, 95, 96, 97, 98, 100, 104, 115

Index 119

Stress, 13, 15, 17, 29, 33, 43, 59, 88, 92, 104, 113, 115 Stroke, 8, 38, 39, 66, 115 Subacute, 8, 100, 115 Subarachnoid, 97, 115 Subcutaneous, 107, 115 Subspecies, 114, 115 Substance P, 102, 113, 115 Suction, 96, 115 Sudden cardiac death, 11, 115 Sympathomimetic, 84, 94, 95, 106, 115 Synapse, 83, 93, 110, 115, 116, 117 Synapsis, 115, 116 Synaptic, 7, 105, 113, 116 Synaptic Transmission, 105, 116 Synaptic Vesicles, 116 Synergistic, 110, 116 T Tardive, 85, 90, 116 Teratogen, 46, 116 Testosterone, 31, 116 Thalidomide, 46, 116 Threshold, 96, 99, 116 Thrombocytes, 109, 116 Thrombosis, 110, 115, 116 Thyroid, 14, 99, 116, 117, 118 Thyroid Gland, 99, 117 Thyroid Hormones, 14, 117, 118 Thyrotropin, 99, 117 Tissue, 86, 87, 88, 92, 95, 101, 102, 104, 105, 107, 112, 114, 117 Tonicity, 95, 117 Topical, 95, 117 Toxic, iv, 24, 26, 86, 102, 105, 117

Toxicokinetics, 117 Toxicology, 10, 23, 68, 117 Trachea, 116, 117 Transdermal, 42, 117 Transmitter, 83, 94, 100, 102, 106, 116, 117 Tremor, 53, 117 Tricyclic, 83, 84, 90, 93, 99, 117 Tryptophan, 113, 117 Tumor marker, 87, 117 Tumor Necrosis Factor, 116, 117 Tyrosine, 94, 118 U Unconscious, 99, 118 V Vaccine, 110, 118 Vagina, 102, 118 Vaginal, 19, 118 Vasodilator, 94, 118 VE, 13, 118 Venlafaxine, 10, 18, 23, 118 Venous, 110, 118 Venules, 87, 88, 118 Veterinary Medicine, 68, 118 Viloxazine, 23, 118 Virulence, 16, 118 Viruses, 118 Vitro, 118 Vivo, 118 Vulva, 5, 118 W War, 109, 118 Windpipe, 116, 118 X X-ray, 52, 53, 111, 118

120 Zoloft

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