Date: {{$ActivityAssignDate}}

Dear Dr. {{ $doctorName }},

Subject: : A survey to assess the usage pattern of sertraline in the management of depression in India

Major depressive disorder (MDD) is a debilitating disease that is characterized by at least one discrete depressive episode lasting at least 2 weeks and involving clear-cut changes in mood, interests and pleasure, changes in cognition and vegetative symptoms.ⁱ Depression is a common mental health disorder that can affect both the mental and physical health. The number of incident cases of depression worldwide increased from 172 million in 1990 to 258 million in 2017, representing an increase of 49.86%.ⁱⁱ In 2017, 197•3 million people had mental disorders in India, including 45•7 million with depressive disorders and 44•9 million with anxiety disorders.ⁱⁱⁱ Large-scale longitudinal studies converge in their findings suggesting that MDD increases the risk of diabetes mellitus, heart disease, stroke, hypertension, obesity, cancer, cognitive impairment and Alzheimer disease.^iv Neurocognitive impairment is a relevant factor in the quality of life of patients, as it is negatively associated with psychosocial functioning in MDD.^v

Treatment options for management of depression can be broadly be divided into antidepressants, electroconvulsive therapy (ECT) and psychosocial interventions. In general, because of the side effect and safety profile, selective serotonin reuptake inhibitors (SSRIs) are considered to be the first line antidepressants. Other preferred options include tricyclic antidepressants, mirtazapine, bupropion, and venlafaxine. Usually, the medication must be started in the lower doses and the doses must be titrated, depending on the response and the side effects experienced.^vi

Sertraline is selective serotonin reuptake inhibitor (SSRI). SSRIs exert their mechanism of action by binding to the sodium-dependent serotonin transporter protein (SERT) in the presynaptic neuron. SERT is responsible for reuptaking serotonin from the synaptic cleft into the presynaptic neuron. Inactivation of SERT by sertraline leads to an elevation in synaptic serotonin levels.

In a 6-week, randomized, double-blind, multicenter trial showed that all dosages of sertraline (50, 100, and 200 mg/day) were substantially more effective than placebo in treating major depression. By the intention-to-treat analysis, sertraline 50 mg/day demonstrated a trend for superiority in efficacy to the higher dosage levels on most parameters.^vii

This survey has been undertaken to understand the usage pattern of Sertraline in the management of depression in India

As you will be spending some extra time to give your feedback on the questionnaire based on your clinical experience, we offer to pay you by cheque a professional fee of Rs {{$contractAmount}}, on receiving the completed Survey Questionnaire Form from you.

We trust you and we are partners in promoting effective drug therapy. In that spirit we hope you will consent to participate in this survey. If you do, please sign and return the enclosed reply along with your visiting card for accuracy of records.