Recommended Starting Dose of Sertraline
The recommended starting dose of sertraline for adults with major depressive disorder and obsessive-compulsive disorder is 50 mg once daily. 1
Adult Dosing by Indication
- For major depressive disorder (MDD) and obsessive-compulsive disorder (OCD), initiate treatment at 50 mg once daily 1
- For panic disorder, posttraumatic stress disorder (PTSD), and social anxiety disorder, start at 25 mg once daily for one week, then increase to 50 mg once daily 1
- For premenstrual dysphoric disorder (PMDD), begin with 50 mg/day, either daily throughout the menstrual cycle or limited to the luteal phase 1
Pediatric Dosing
- For children ages 6-12 with OCD, start with 25 mg once daily 2, 1
- For adolescents ages 13-17 with OCD, start with 50 mg once daily 2, 1
- Pediatric patients should be monitored closely for clinical worsening, suicidality, and unusual behavior changes, especially during the initial few months of treatment 2, 3
Dose Titration and Maximum Dosage
- Patients not responding to initial doses may benefit from dose increases up to a maximum of 200 mg daily 2, 1
- Dose increases should be made in 50 mg increments 2, 1
- Due to sertraline's 24-hour elimination half-life, dose changes should not occur at intervals of less than 1 week 1
Administration Considerations
- Sertraline can be administered once daily, either in the morning or evening 1
- No dose adjustments are needed for elderly patients, unlike some other SSRIs 4
- Sertraline has less effect on the metabolism of other medications compared to other SSRIs, resulting in fewer drug-drug interactions 2, 3
Clinical Pearls and Pitfalls
- Research suggests that the 50 mg starting dose is the optimal dose for most patients with depression when considering both efficacy and tolerability 4
- Studies indicate that continuing treatment at 50 mg yields comparable response rates to dose escalation to 150 mg after 3 weeks of treatment for most patients 5
- When discontinuing sertraline, it should be slowly tapered to avoid withdrawal effects 2
- Common side effects include sweating, tremors, nervousness, insomnia or somnolence, dizziness, gastrointestinal disturbances, and sexual dysfunction 3
- Pharmacokinetic studies show that sertraline's parameters in children and adolescents are similar to adult values when normalized for body weight 6