From the Guidelines
When increasing your sertraline dose, expect potential side effects that typically last 1-2 weeks before improving, and to minimize discomfort, increase gradually, usually by 25-50mg increments, as recommended by the most recent clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1.
Potential Side Effects
Some common temporary effects include:
- Increased anxiety
- Insomnia
- Nausea
- Headaches
- Dizziness
- Sometimes worsened fatigue Sexual side effects like decreased libido or delayed orgasm may also occur. Most people find these effects are milder than when first starting the medication.
Minimizing Discomfort
To reduce stomach upset, take the medication with food, and consider splitting the increase over morning and evening if taking twice daily. Stay hydrated and maintain regular sleep patterns. The full therapeutic benefit of the increased dose typically takes 4-6 weeks to develop.
Monitoring and Follow-up
Contact your doctor if you experience severe side effects, significant mood changes, or suicidal thoughts. These temporary adjustment effects occur because sertraline affects serotonin levels in your brain, and your body needs time to adapt to the new concentration of the medication, as noted in the guidelines for managing anxiety disorders 1.
Key Considerations
It is essential to follow the recommended dosage increments and monitoring guidelines to ensure safe and effective treatment, as outlined in the clinical practice guideline 1. Additionally, be aware of potential drug interactions, especially with other serotonergic drugs, and monitor for symptoms of serotonin syndrome, as cautioned in the guideline 1.
From the FDA Drug Label
Patients not responding to a 50 mg dose may benefit from dose increases up to a maximum of 200 mg/day. Given the 24 hour elimination half-life of sertraline, dose changes should not occur at intervals of less than 1 week
- When increasing the sertraline dose, patients may benefit from dose increases up to a maximum of 200 mg/day.
- Dose changes should not occur at intervals of less than 1 week, due to the 24 hour elimination half-life of sertraline 2.
From the Research
Increasing Sertraline Dose: Expected Outcomes
- When increasing the sertraline dose, patients can expect potential improvements in depressive symptoms, although this may not always be the case 3, 4.
- The optimal dose of sertraline for most patients is 50 mg/day, but it can be increased in 50 mg/day increments at no less than weekly intervals to a maximum of 200 mg/day if an adequate therapeutic response is not achieved within 24 weeks 3.
- Increasing the dose may lead to reduced anxiety symptoms, better mental health-related quality of life, and self-reported improvements in mental health, as observed in some studies 4.
- However, it is essential to note that higher doses may also increase the risk of adverse events, such as sexual dysfunction, which has been reported to be positively correlated with dose 5.
Pharmacokinetics and Drug Interactions
- Sertraline has a half-life of approximately 1 day, and its pharmacokinetics are linear, meaning that plasma concentrations increase proportionally with dosage increases 6.
- Unlike some other SSRIs, sertraline does not inhibit its own metabolism and has minimal effects on cytochrome P450 (CYP) enzymes, reducing the likelihood of clinically important pharmacokinetic drug-drug interactions 6.
- However, age-related increases in plasma drug concentrations have been observed in healthy elderly persons, and there is an age-gender interaction for sertraline, with its plasma concentrations being 35 to 40% lower in young men than in elderly or young females or elderly males 6.
Adverse Events and Tolerability
- Common adverse events associated with sertraline include sexual dysfunction, which can be dose-dependent and may improve when the dose is diminished or the drug is withdrawn 5.
- Other adverse events, such as nausea, headache, and insomnia, may also occur, but the frequency and severity of these events may vary depending on the individual patient and the dose used 4.
- It is crucial to monitor patients closely when increasing the sertraline dose and to adjust the dose or discontinue treatment if adverse events become intolerable or severe 3, 4.