The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.

The article was promoted 18:17, 6 May 2008.

Sertraline[edit]

Self-nominator Paul Gene (talk) 12:28, 26 April 2008 (UTC)[reply]

Comments

• Support. Excellent, well-written. Couple things though, (a) the lead sometimes strays into describing what the subject is not, rather than what it is and ends with side effects of another compound altogether; (b) it may be useful to put some "Mechanism of action" into the lead telling us, in plain/accessible language, what it does (inhibits serotonin reuptake how exactly), the article is dominated by its effects (anti-depressant + side effects) but there are a two sections of what it does; (c) structurally, I don't quite see the need for "Suicidality in adults" as a sub-sub-section, why not just a second paragraph for the sub-section "Suicidality"? --maclean 18:55, 26 April 2008 (UTC)[reply]

a)fixed. b)All is known about the mechanism of action of sertraline is that it inhibits serotonin reuptake by binding to serotonin transporter. Anything else is hypothesizing since the mechanisms of psychiatric disorders it treats are unknown. Such hypotheses are not specific to sertraline and are best addressed in general articles on SSRIs and antidepressants. c) fixed Paul Gene (talk) 23:55, 26 April 2008 (UTC)[reply]

• Very minor starting comments
  • In the lead, do you think "There are indications..." could be changed to "There is evidence..." or "Evidence suggests..."?
  • As the only international trade name for a drug available in the U.S. appears to be "Lustral" in the lead, I've added a footnote stating "Medication trade names may differ between countries. In general, this article uses North American trade names." A similar note is used in Tourette syndrome, and I've considered recommending its use in drug articles; please revert if it's inaccurate. Fvasconcellos (t·c) 01:46, 27 April 2008 (UTC)[reply]

Changed the lead to Evidence suggests... Paul Gene (talk) 02:31, 27 April 2008 (UTC)[reply]

Thanks. The new, longer lead is excellent, although I think mentioning its use in pregnancy is unnecessary. Fvasconcellos (t·c) 13:59, 27 April 2008 (UTC)[reply]

I am not sure. It seems like a serious side effect, which may be of potential concern for the majority of sertraline users (women of childbearing age). It is also not mentioned in the prescribing information. Any other opinions - pro or contra? Paul Gene (talk) 14:36, 27 April 2008 (UTC)[reply]

• MOS:CAPS#All caps (in the citations). SandyGeorgia (Talk) 02:44, 27 April 2008 (UTC)[reply]

Fixed. Thank you for your help. Paul Gene (talk) 03:09, 27 April 2008 (UTC)[reply]

• Comment - sorry, something came up in RL and I have been off wikipedia. My one thing I wanted to fix before coming to FAC was to get a few more facts from outside the US to get into the article. I can do this in a couple of days if no-one else does. eg timing of licencing, rank in antidepressants etc. outside of US. Cheers, Casliber (talk · contribs) 21:29, 27 April 2008 (UTC)[reply]

Yes, please do it if you can. Thank you. Paul Gene (talk) 10:19, 28 April 2008 (UTC)[reply]

I got some figures from 98 & 00-01, when it peaked in Oz. The note on being top seller in US needs to be in body of text too. Some other figures from UK and Europe'd be good. Cheers, Casliber (talk · contribs) 08:55, 30 April 2008 (UTC)[reply]

I added rankings for the UK, Canada and Australia. As for the other countries, I would like to point out that this is the English language Wikipedia. While the article should be comprehensive, there is no mandate to cover Europe and other countries. Unless notable, such information on approval dates and prescribing trends would amount to little more than useless trivia. Paul Gene (talk) 15:59, 30 April 2008 (UTC)[reply]

I did start pondering the same thing and agree. Cheers, Casliber (talk · contribs) 20:44, 30 April 2008 (UTC)[reply]

• Support This article seems like a great example of wikipedia's best work. One of the few minor things I noticed is that Sertraline#Controversy uses a few wordings that seem as though they could indicate bias, such as "To the FDA's credit...". I think it might also be useful to contrast the claims about Sertraline made in that section with, for example, evidence in support of Pfizer, so as to not make the entire section seem as though nobody supports Pfizer's claims about Zoloft's safety.CrazyChemGuy (talk) 01:24, 30 April 2008 (UTC)[reply]

Fixed "To the FDA's credit..." wording. Actually, there are no claims that Zoloft is unsafe in the Sertraline#Controversy part. There are only facts and quotations. An Australian guy took 250 mg of sertraline on the first day, instead of 50 mg the doctor prescribed him, had a psychosis and killed his wife. Of course, the court was correct, it would have not happened if he was not prescribed sertraline. But is it sertraline to blame, or Pfizer, or the guy himself? The reader should make his own conclusion. Paul Gene (talk) 01:59, 30 April 2008 (UTC)[reply]

• Comment. The history section lacks sufficient historical context. There is no explanation of why Pfizer was researching neurotransmitter uptake inhibitors. Around that time, there was a sea change in conceptions of depression (which was increasingly being considered in physiological terms rather than psychoanalytic), and the specifics of the physiological depression models influenced the choice of research at Pfizer, Eli Lilly and elsewhere; this is hinted at by the fact that it was originally being investigated not as a seratonin reuptake inhibitor but a norepinephrine reuptake inhibitor. The history section should also address sertraline's changing place in the broader context of the antidepressant market, since the sertraline's market history is tied up with that of Prozac and other drugs. Also, something should be mentioned about the markets where sertraline is not approved, and why. Jonathan Metzl's Prozac on the Couch (which deals with Zoloft and other drugs as well) is a good starting point to fill some of the holes. I'll try to identify some other appropriate sources as well.--ragesoss (talk) 18:15, 30 April 2008 (UTC)[reply]
  • A colleague of mine suggested David Healy's The Antidepressant Era as another source (probably better than Metzl's book) for putting sertraline into broader historical context. --ragesoss (talk) 01:02, 1 May 2008 (UTC)[reply]

a)This comment is unactionable. No explanation of why Pfizer was researching neurotransmitter uptake inhibitors exists in the literature, and Healy did not interview anybody from Pfizer for his books. Anything written about it would be just a speculation. b)Sertraline's market histories are very different in different countries for no easily identifiable reasons, so no lessons can be extracted from there. This was already discussed in my answers to Casliber comments when the article was a GA candidate. c)Similarly unactionable is the comment about the markets where sertraline is not approved. There are more than 190 countries, and researching even the upper 20% is an onerous burden. I have not encountered anything of notability regarding non-approval of Zoloft. And when referring to Prozac and other SSRI's and sufficient historical context please remember, this is not a book about SSRI's we are discussing, but an article about sertraline. Paul Gene (talk) 01:27, 1 May 2008 (UTC)[reply]

I realize that this is a limited-scope article, and if there is nothing significant about why the drug was not more widely approved, that's fine. But I think the historical context of sertraline being developed during a period when medical ideas about depression and the proper treatment for it are swinging towards pharmaceuticals is key context for the history of sertraline. Just because Healy didn't interview anyone from Pfizer doesn't mean his analysis of the historical context of antidepressant development (including sertraline's) isn't significant or accurate. Asking for better historical context, when such context is discussed in available historical literature, is definitely an actionable suggestion.--ragesoss (talk) 03:01, 1 May 2008 (UTC)[reply]

I submit that this comment is still unactionable. (a) First you say that you "realize that this is a limited scope article" but then you still demand "analysis of the historical context of antidepressant development". There is nothing specifically notable about sertraline as compared, for example, to citalopram development, so the general context is best addressed in general articles on SSRIs and antidepressants. (b) To say that sertraline was "developed during a period when ideas about depression and the proper treatment for it were swinging towards pharmaceuticals" is incorrect. The swing of ideas you refer to happened in 1960s and is related to a development of first neuroleptics and tricyclic antidepressants. Most of the work on sertraline has been done in the 80s, with several SSRIs on the market or in advanced stages of development, and it was by no means notable, just another me-too drug. Paul Gene (talk) 10:44, 1 May 2008 (UTC)[reply]

Another key aspect of the history that is missing is the development of an industrial process for commercial-scale sertraline production. This is an important part of the history of most drugs, but for most drugs nothing has been written about that aspect of the history. Fortunately that's not the case with sertraline, which had particularly interesting problems to overcome since it used a strictly chemical synthesis to produce a chiral product : see George J. Quallich, "Development of the commercial process for Zoloft®/sertraline", Chirality, Volume 17, Issue S1 , Pages S120 - S126 (2004).--ragesoss (talk) 03:36, 1 May 2008 (UTC)[reply]

It is always a case that during the development of the process for a manufacture of a new drug, that the process chemists have to overcome some specific problems. Contrary to what you think ("for most drugs nothing has been written about that aspect"), the process development part is usually published in some specialist journal. There is nothing notable about it, you can find dozens of examples in every issue of Organic Process Research and Development journal. Sertraline was not the first chiral drug on the market, and including the industrial process would overburden the article with details, which are not of any interest to a general audience and beyond its comprehension, and even of no interest to specialists since as I mentioned above, there are multiple examples of a process development routine. Paul Gene (talk) 11:03, 1 May 2008 (UTC)[reply]

Maybe I underestimate the general availability of publications on development (it's something that is beginning to see more attention from historians, at least, and is still underrepresented in that literature). But development process is definitely something that should be addressed in the article.--ragesoss (talk) 15:15, 1 May 2008 (UTC)[reply]

I am not sure, for the reasons I listed above. Would anybody else, either professional or lay reader comment on this issue, please. Paul Gene (talk) 15:37, 1 May 2008 (UTC)[reply]

:::::: It is a great shame there is not a history section in the general SSRI article as yet, as that would be the place to have a seealso at the top of this page's history section. I am reading some stuff currently. Cheers, Casliber (talk · contribs) 00:54, 2 May 2008 (UTC) fixed.[reply]

• Support Excellent article. Well-written, well-cited. I can't really find anything wrong with it. Dr. Cash (talk) 17:24, 2 May 2008 (UTC)[reply]

• Support - exactly what the doctor ordered :). Excellent tweak to just add that little bit of context and make it a top-quality article. Congrats. Cheers, Casliber (talk · contribs) 02:56, 3 May 2008 (UTC)[reply]

• Support. All I had to see were these tweaks the doctor ordered, and make sure they wouldn't make the article worse ;) I do think there's a bit too much emphasis on R v Hawkins in the "Controversy" section, but I can't fault the article anywhere else. The prose is clear, MOS appears to have been followed to the letter, high-quality sources were used throughout, and the article is as comprehensive as I could ever wish it to be... Excellent work. Now, to the Main Page! :) Fvasconcellos (t·c) 13:59, 3 May 2008 (UTC)[reply]

  I hear you on the R v Hawkins case, however it was big news here in Oz and much discussed in psychiatric circles as well as popular news. Cheers, Casliber (talk · contribs) 20:27, 3 May 2008 (UTC)[reply]

• Support Unconditional with one nitpick. This sounds odd to me: Many of them subsequently dropped off from the study due to the side effects, possibly withdrawal syndrome, and worsening of the OCD symptoms. Is there a better way of saying dropped off from? And were they excluded by the research team or did they self-withdraw? GrahamColm^Talk 16:33, 4 May 2008 (UTC)[reply]

Changed wording to "dropped out of the study" as in the original. The reasons listed in the article: relapse, insufficient clinical response, not eligible to continue, adverse effects, protocol violation, withdrawal of consent, lost to follow up and others. So I opted not to specify them except the two major ones, on which the placebo (discontinuation) and sertraline (continuation) group differed.

The above discussion is preserved as an archive. Please do not modify it. No further edits should be made to this page.