Medical Matters > Treatment: Selective Serotonin Reuptake Inhibitors

ME Essential Summer 2021

Question

My doctor has suggested that I might like to try using a drug called sertraline (trade name is Lustral). I know it’s normally used to treat depression but he says that it may be worth trying because ME can upset the levels of chemical transmitters in the brain and this drug can help to increase the level of one called serotonin. Is this drug safe? And is there any evidence that it can be used to treat ME?

Answer

Sertraline belongs to a group of drugs called SSRIs (Selective Serotonin Reuptake Inhibitors) and they act by increasing the level of serotonin in the brain and there is some research evidence to indicate that there are changes in the status of this brain-chemical transmitter in people with ME/CFS. A small number of clinical trials involving SSRI drugs, including sertraline, have also been carried out in ME/CFS. But there is no evidence from these trials to indicate that SSRI's are of any benefit.

However, I do receive very occasional anecdotal reports from people who have found an SSRI drug like this to be helpful. On the other hand, there are other people with ME/CFS who are sensitive to SSRI drugs – even at very low doses. This has to be regarded as a very speculative form of treatment that could exacerbate ME/CFS, but if it is going to be tried then it should start with a low dose that is then increased very gradually. Finally, SSRI drugs should not be prescribed in combination with tricyclic antidepressant drugs such as amitriptyline.

WebMD: 

Serotonin: 9 Questions and Answers | October 2011

Serotonin acts as a neurotransmitter, a type of chemical that helps relay signals from one area of the brain to another. Although serotonin is manufactured in the brain, where it performs its primary functions, some 90% of our serotonin supply is found in the digestive tract and in blood platelets.

Serotonin is made via a unique biochemical conversion process. It begins with tryptophan, a building block to proteins. Cells that make serotonin use tryptophan hydroxylase, a chemical reactor which, when combined with tryptophan, forms 5-hydroxytryptamine, otherwise known as serotonin.

As a neurotransmitter, serotonin helps to relay messages from one area of the brain to another. Because of the widespread distribution of its cells, it is believed to influence a variety of psychological and other body functions.

This includes mood, sexual desire and function, appetite, sleep, memory and learning, temperature regulation, and some social behavior. In terms of body function, serotonin can also affect the functioning of the cardiovascular system, muscles, and various elements in the endocrine system.

See also:

    • 5-HTP (5-Hydroxytryptophan).
    • Trytophan.

More information

The ME Association has several detailed leaflets that include information about symptom-relieving medications such as SSRIs:

MEDICAL DISCLAIMER

Medical Matters is for information purposes only. The answers provided by Dr Shepherd and the ME Association’s other expert advisers should not be construed as medical advice. We recommend that any information you deem relevant is discussed with your GP as soon as possible. It is important to obtain advice from a GP who is in charge of your clinical care, who knows you well, and who can consider other likely causes for symptoms. Seek personalised medical advice whenever a new symptom arises, or an existing symptom worsens. Don't assume that new or worsened symptoms are a result of having ME/CFS.

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