Recommended Use and Dosage of Zoloft (Sertraline)
Zoloft (sertraline) should be initiated at 50 mg once daily for major depressive disorder, with dose adjustments up to a maximum of 200 mg daily based on clinical response, with dose changes occurring at intervals of not less than one week. 1
Indications for Sertraline
Sertraline is FDA-approved for the treatment of:
- Major Depressive Disorder (MDD)
- Obsessive-Compulsive Disorder (OCD)
- Panic Disorder
- Post-Traumatic Stress Disorder (PTSD)
- Social Anxiety Disorder
- Premenstrual Dysphoric Disorder (PMDD)
Dosing Guidelines by Indication
Major Depressive Disorder and OCD (Adults)
Panic Disorder, PTSD, and Social Anxiety Disorder
- Initial dose: 25 mg once daily for the first week 1
- Increase to 50 mg once daily after one week 1
- Dose range: 50-200 mg daily 1
- Maximum dose: 200 mg daily 1
Premenstrual Dysphoric Disorder
- Initial dose: 50 mg daily 1
- Can be administered either daily throughout the menstrual cycle or limited to the luteal phase 1
- Dose range: 50-150 mg daily 1
- Maximum dose: 150 mg daily when dosing throughout the cycle; 100 mg daily when dosing during luteal phase only 1
Pediatric OCD
- Children (6-12 years): Initial dose 25 mg once daily 1
- Adolescents (13-17 years): Initial dose 50 mg once daily 1
- Maximum dose: 200 mg daily 1
Administration Guidelines
- Administer once daily, either in the morning or evening 1
- Dose adjustments should not occur at intervals less than 1 week due to sertraline's 24-hour elimination half-life 1, 3
- Sertraline can be taken with or without food
Dose Titration and Monitoring
- For patients not responding to initial doses, increase by 50 mg increments at intervals of at least one week 1
- Monitor patients regularly, beginning within 1-2 weeks of initiation 2
- Assess therapeutic response and adverse effects at each visit 2
- If inadequate response after 6-8 weeks, modify treatment 2
Duration of Treatment
- For major depressive disorder, continue treatment for at least 4-9 months after satisfactory response for first episode 2
- For patients with 2 or more episodes of depression, longer treatment duration may be beneficial 2
- Maintenance treatment has demonstrated efficacy for up to 44 weeks following 8 weeks of initial treatment 1
Pharmacokinetics
- Elimination half-life: 22-36 hours 3
- Undergoes extensive first-pass metabolism to form N-desmethyl-sertraline (weakly active metabolite) 3
- Steady-state plasma concentrations vary widely (up to 15-fold) in patients receiving 50-150 mg/day 3
Side Effects
- Common side effects include nausea, diarrhea, headache, insomnia, and sexual dysfunction 2, 4
- Compared to other SSRIs, sertraline has less effect on metabolism of other medications 2
- Well tolerated in therapeutic doses and relatively safe in overdose 3
- Monitor for increased risk of suicidal thoughts and behaviors, especially in the first 1-2 months of treatment 2
Clinical Pearls
- Sertraline is well-tolerated compared to tricyclic antidepressants 5
- Has minimal anticholinergic activity and is essentially devoid of cardiovascular effects 5
- Can be safely administered to elderly patients or those with underlying cardiovascular disorders 5
- For panic disorder, sertraline has shown efficacy in reducing severity and frequency of panic attacks 6
- Sertraline has minimal inhibitory effects on major cytochrome P450 enzymes, resulting in fewer drug-drug interactions compared to other antidepressants 3
Common Pitfalls to Avoid
- Discontinuing treatment too early (continue for at least 4-9 months after remission)
- Increasing doses too rapidly (maintain at least one week between dose adjustments)
- Failing to monitor for emergence of suicidal thoughts, especially in the first 1-2 months
- Not assessing response at regular intervals (should be assessed within 1-2 weeks of initiation)
- Overlooking the need to modify treatment if inadequate response after 6-8 weeks