Use of sertraline hydrochloride in the treatment of refractory neurocardiogenic syncope in children and adolescents

Abstract

The serotonin reuptake inhibitor sertraline hydrochloride can be effective in preventing recurrent neurocardiogenic syncope in selected patients unresponsive to or intolerant of other therapeutic modalities.

Syncope

“…Other selective serotonin reuptake inhibitors such as fluoxetine and sertraline are less well tolerated when used for vasovagal syncope. 94,96 Clinical experience has not replicated the dramatic results of the one randomized trial.…”

“…Grubb et al 94 proposed that selective serotonin reuptake inhibitors reduce vasovagal syncope by downregulating postsynaptic central serotonin receptor levels, blunting the response to abrupt changes in central serotonin levels. In the only randomized, double-blind, placebo-controlled trial of selective serotonin reuptake inhibitors, paroxetine reduced the recurrence of vasovagal syncope by 82.4% compared with 47.1% in the placebo arm (P<0.001) over 2 years.…”

Serotonin Reuptake Inhibitor (Paxil) Does Not Prevent the Vasovagal Reaction Associated With Carotid Sinus Massage and/or Lower Body Negative Pressure in Healthy Volunteers

“…In the remaining 13 patients, 7 had a negative repeat tilt test and remained asymptomatic over a mean follow-up period of 19Ϯ9 months. Similarly, in another study from the same group, 16 …”

“…On the basis of these animal studies, several investigators have examined the usefulness of serotonin reuptake inhibitors as a therapy for neurally mediated cardiovascular disorders. [5][6][7]16 The Role of SSRIs in Neurally Mediated Cardiovascular Disorders…”

Neurally Mediated Syncope

“…This change is postulated to prevent overstimulation of the postsynaptic area by a surge of serotonin. 30 Paroxetine, 31 fluoxetine, 32 and sertraline 33 are selective seroto-nin reuptake inhibitors useful in treating NMS. Although generally well tolerated, these drugs may cause anxiety, headache, or insomnia in some patients.…”