The Effects of Treatment With Sertraline for Noncardiac Chest Pain

Noncardiac chest pain remains an important problem in clinical cardiology. Often, panic disorder and/or depression are the underlying cause. However, this is largely underdiagnosed.

There are no clear existing treatment strategies/methods for this specific patient population.

In our double blind, placebo controlled care as usual versus sertraline study, we want to investigate whether intervention is more effective as care as usual for diminishing chest pain, and also if sertraline is more effective in this specific population compared to placebo.

• Panic Attacks
• Chest Pain
• Depression

• Drug: sertraline
  starting dose 25 mg for 1 week, the increasing to 50 mg, after each visit evaluation whether dosage has to be increased to maximally 150 mg
  Other Name: sertraline, zoloft
• Drug: placebo
  patients received 1 pill, according to their complaints the number of pills was increased to maximally 3

• Active Comparator: sertraline, panic education
  treatment with sertraline after panic education
  Intervention: Drug: sertraline
• Placebo Comparator: placebo after panic education
  treatment with placebo after panic education
  Intervention: Drug: placebo
• No Intervention: care as usual
  patient received no diagnosis an no panic education, they had a 24 weeks follow up with a visit at 12 weeks and 24 weeks to evaluate their complaints

Inclusion Criteria:

• chest pain without a cardiac cause
• diagnosed with panic disorder and or depression according to Diagnostic and statistical Manual (DSM) IV criteria
• Living < 50 km from the hospital
• informed consent

Exclusion Criteria:

• other primary DSM IV diagnosis
• known sensitivity to sertraline
• using other anti-depressive agents
• not speaking dutch language
• living in a nursery home or having dementia
• other severe, acute or progressive disease, kidney or liver-function disturbances, pregnancy or breastfeeding