Recommended Dosage of SSRIs for Anxiety
For adults with anxiety disorders, sertraline should be initiated at 25 mg once daily for one week, then increased to 50 mg once daily, with potential dose increases up to a maximum of 200 mg/day based on clinical response. 1
Initial Dosing and Titration
- Sertraline treatment for anxiety disorders (including social anxiety disorder and panic disorder) should begin with 25 mg once daily for the first week 1
- After the first week, increase to 50 mg once daily, which is the recommended initial therapeutic dose 1
- Dose changes should not occur at intervals less than 1 week due to sertraline's 24-hour elimination half-life 1
- Sertraline can be administered once daily, either in the morning or evening 1
Dose Adjustment and Maximum Dosage
- Patients not responding to 50 mg/day may benefit from dose increases up to a maximum of 200 mg/day 1
- Clinical trials demonstrating effectiveness for anxiety disorders used doses ranging from 50-200 mg/day 1, 2
- The best-fitting model for SSRI response shows clinically significant improvement by week 6 and maximal improvement by week 12 or later 3
- This pharmacodynamic profile supports slow up-titration to avoid unintentionally exceeding the optimal medication dose 3
Efficacy and Monitoring
- SSRIs are suggested as first-line treatment for anxiety disorders with a "weak" strength of recommendation but supported by clinical evidence 3
- Sertraline has demonstrated efficacy in treating various anxiety disorders including social anxiety disorder, panic disorder, and generalized anxiety disorder 2, 4, 5
- Monitor for response within 4-6 weeks of reaching a therapeutic dose 6
- For social anxiety disorder, sertraline's efficacy is maintained for periods up to 24 weeks following 20 weeks of treatment 1
Side Effects and Precautions
- Most adverse effects emerge within the first few weeks of treatment and can include dry mouth, nausea, diarrhea, headache, somnolence, insomnia, and changes in appetite 3
- Potentially serious adverse effects to monitor include suicidal thinking/behavior (particularly in patients under 24 years), behavioral activation/agitation, hypomania/mania, and serotonin syndrome 3
- Behavioral activation/agitation is more common in anxiety disorders compared to depressive disorders and may occur early in SSRI treatment or with dose increases 3
- Close monitoring for suicidality is recommended by the FDA, especially in the first months of treatment and following dosage adjustments 3
Alternative Options
- Other SSRIs approved in various countries for anxiety disorders include fluvoxamine, paroxetine, and escitalopram 3
- Venlafaxine (an SNRI) is also suggested as an alternative option for anxiety disorders 3
- Cognitive behavioral therapy (CBT) is recommended as a non-pharmacological treatment option, particularly for social anxiety disorder 3
Maintenance Treatment
- For social anxiety disorder, patients should be periodically reassessed to determine the need for maintenance treatment 1
- Dosage adjustments should aim to maintain patients on the lowest effective dose 1
- For panic disorder, sertraline has been found to reduce severity and frequency of panic attacks and provide protection from relapse for up to 36 weeks following withdrawal from medication 2