What is the recommended dose of Zoloft (sertraline)?

Recommended Dosing of Sertraline (Zoloft)

The recommended initial dose of sertraline (Zoloft) for adults with major depressive disorder is 50 mg once daily, with a maximum dose of 200 mg daily. 1

Adult Dosing Guidelines

Initial Dosing

• Major Depressive Disorder and OCD: 50 mg once daily 1
• Panic Disorder, PTSD, and Social Anxiety Disorder: 25 mg once daily for one week, then increase to 50 mg once daily 1
• Premenstrual Dysphoric Disorder: 50 mg daily (either throughout menstrual cycle or limited to luteal phase) 1

Dose Titration

• Dose increases should not occur at intervals less than 1 week due to sertraline's 24-hour elimination half-life 1
• Patients not responding to 50 mg may benefit from dose increases up to a maximum of 200 mg/day 1
• For most patients, 50 mg/day is the optimal dose when considering both efficacy and tolerability 2

Administration

• Sertraline should be administered once daily, either in the morning or evening 1
• May be taken with or without food
• Unlike some other SSRIs, no dose adjustment is needed for elderly patients 2

Pediatric Dosing

Children (6-12 years)

• OCD: Start with 25 mg once daily 1
• May increase up to maximum of 200 mg/day based on response 1

Adolescents (13-17 years)

• OCD: Start with 50 mg once daily 1
• May increase up to maximum of 200 mg/day based on response 1
• Consider lower body weights when advancing doses to avoid excess dosing 1

Special Considerations

Maintenance Treatment

• For major depressive disorder, efficacy is maintained for periods up to 44 weeks following 8 weeks of initial treatment at doses of 50-200 mg/day (mean dose 70 mg/day) 1
• Periodic reassessment is recommended to determine need for maintenance treatment 1

Dose Optimization

• Research suggests that for most patients, continued treatment with 50 mg dose yields a comparable antidepressant response to dose escalation from 50 mg to 150 mg after 3 weeks of treatment 3
• While some patients clearly benefit from higher doses, there is a lack of evidence for a dose-response curve with sertraline in depression treatment 3

Common Pitfalls to Avoid

1. Rapid Dose Escalation: Avoid increasing the dose at intervals less than one week 1
2. Unnecessary Dose Increases: For most patients, 50 mg is the optimal therapeutic dose 2
3. Abrupt Discontinuation: Taper gradually over several weeks when discontinuing to avoid discontinuation syndrome 4
4. Drug Interactions: Use caution when combining with:
   • MAOIs (contraindicated)
   • Medications affecting bleeding risk
   • Medications metabolized by CYP2D6 4

Sertraline is generally well-tolerated with a favorable pharmacokinetic profile. The starting dose of 50 mg for adults (25 mg for children or in anxiety disorders) is appropriate for most patients, with dose adjustments made based on clinical response and tolerability.