What is the starting dose of Zoloft (sertraline) for adults?

Starting Dose of Zoloft (Sertraline) for Adults

The recommended starting dose of Zoloft (sertraline) for adults is 50 mg once daily. 1

Dosing Guidelines by Indication

• For Major Depressive Disorder and Obsessive-Compulsive Disorder:

  • Start with 50 mg once daily 1
  • Can be administered at any time of day 2

• For Panic Disorder, Posttraumatic Stress Disorder, and Social Anxiety Disorder:

  • Start with 25 mg once daily for one week 1
  • Increase to 50 mg once daily after the first week 1

• For Premenstrual Dysphoric Disorder:

  • Start with 50 mg daily, either throughout the menstrual cycle or limited to the luteal phase 1

Dose Adjustments

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

Special Populations

• Elderly patients: No dosage adjustments are warranted for elderly patients solely based on age 3
• The tolerability profile of sertraline is generally similar in younger and elderly patients 3

Clinical Considerations

• Sertraline has a relatively long elimination half-life and fewer drug interactions compared to some other antidepressants 4
• Therapeutic plasma concentration range is 10-50 ng/mL, with mean plasma concentrations of approximately 12±17 ng/mL at 50 mg daily 4
• Research has shown that continuing treatment with 50 mg/day sertraline for patients who don't initially respond may be as effective as dose escalation 5
• One study found that increasing the dose to 200 mg/day in non-responders actually resulted in a lower response rate (56%) compared to maintaining the 100 mg/day dose (70%) 6

Common Side Effects

• Most frequently reported adverse events include dry mouth, headache, diarrhea, nausea, insomnia, somnolence, constipation, dizziness, sweating, and taste abnormalities 4, 3
• Side effects are generally mild and well-tolerated 3

Important Clinical Pitfalls

• Avoid rapid dose escalation before allowing adequate time (at least 1 week) between dose changes 1
• For patients with panic disorder and anxiety disorders, starting at a lower dose (25 mg) helps minimize initial anxiety symptoms that can occur with SSRI initiation 1, 7
• Research suggests that continuing the 50 mg dose for an extended period (up to 8 weeks) may be more beneficial than early dose escalation for non-responders 6