Sertraline Dosing for Major Depressive Disorder in Adults
The recommended initial dose of sertraline for adults with major depressive disorder is 50 mg once daily, which is the usually effective therapeutic dose for most patients. 1, 2
Initial Dosing
- Start with 50 mg once daily (morning or evening) 1
- This starting dose is also the optimal dose when considering both efficacy and tolerability for most patients 3
- No dosage adjustments are needed for elderly patients based solely on age 4, 5
Dose Titration
- For patients not responding to the initial 50 mg dose, increases may be made in 50 mg increments 1
- Dose changes should not occur at intervals of less than 1 week (due to sertraline's 24-hour elimination half-life) 1
- Maximum recommended dose is 200 mg/day 2, 1
Dosing Range and Evidence
- Clinical trials demonstrating effectiveness used doses ranging from 50-200 mg/day 1
- Evidence from fixed-dose studies shows that 50 mg/day is as effective as higher doses with fewer side effects 6
- The American Family Physician guidelines list the outpatient dosage range as 50-200 mg/day 2
Treatment Duration
- Acute episodes of major depressive disorder require several months or longer of sustained pharmacologic therapy beyond response to the acute episode 1
- Clinical guidelines recommend that treatment continue for 4-12 months after a first episode of major depressive disorder 2
- For recurrent depression, prolonged treatment may be beneficial as the probability of recurrence increases with each episode (50% after first episode, 70% after second, 90% after third) 2
Monitoring and Adjustments
- Evaluate response after 4-8 weeks of treatment
- If partial response, consider dose increase
- If no response after adequate trial at maximum tolerated dose, consider switching to another antidepressant
Special Considerations
- Sertraline requires dose adjustment in patients with hepatic impairment 2
- No dose adjustment is needed for renal impairment 2
- Sertraline has a favorable drug interaction profile compared to some other SSRIs, making it a good choice for patients on multiple medications, particularly elderly patients 4, 5
Common Side Effects
- Most common: dry mouth, headache, diarrhea, nausea, insomnia, somnolence, constipation, dizziness, and sweating 4, 5
- Side effects tend to increase with increasing dosage but are usually mild and well tolerated 6
Clinical Pearl
When treating depression, remember that while the FDA-approved dosing range for sertraline is 50-200 mg daily, evidence suggests that many patients respond adequately to the initial 50 mg dose with fewer side effects than higher doses. Always allow at least one week between dose adjustments due to sertraline's pharmacokinetic profile.