Counseling for Patients Starting Sertraline
The recommended initial dose of sertraline is 50 mg once daily, which is both the starting dose and usually effective therapeutic dose for most patients with depression. 1, 2
Dosing Information
- Start with 50 mg once daily for major depressive disorder and obsessive-compulsive disorder 1
- For panic disorder, posttraumatic stress disorder, and social anxiety disorder, start with 25 mg once daily for one week, then increase to 50 mg once daily 1
- Sertraline can be taken at any time of day (morning or evening) 1, 2
- Dose adjustments should not occur at intervals less than one week due to sertraline's 24-hour elimination half-life 1
- If needed, dose can be increased in 50 mg increments up to a maximum of 200 mg daily, though 50 mg is often sufficient for therapeutic effect 1, 2
Side Effects to Discuss with Patient
- Common side effects include sweating, tremors, nervousness, insomnia or somnolence, dizziness, headache, dry mouth, diarrhea, nausea, constipation, and sexual disturbances 3
- Side effects are typically mild, well-tolerated, and often diminish over time 4
- Side effect incidence is related to dosage, with lower doses (50 mg) having fewer side effects 5
- Sertraline has less effect on metabolism of other medications compared to other SSRIs 3
- Weight changes are minimal compared to some other antidepressants 4
Important Counseling Points
- Therapeutic effect may take 2-4 weeks to become apparent; encourage patience with treatment 6
- Advise against sudden discontinuation or rapid dose reduction to avoid withdrawal symptoms 3
- Warn about potential serotonin syndrome if combined with other serotonergic medications (symptoms include muscle twitching, agitation, confusion, sweating, fever) 3
- Avoid use in patients with bipolar depression due to risk of mania 3
- No dosage adjustments are needed for elderly patients based solely on age 2, 6
- Sertraline may help with both depressive symptoms and anxiety symptoms 7
Monitoring and Follow-up
- Schedule follow-up within 2-4 weeks to assess initial response and side effects 1
- If no response after 4-6 weeks at 50 mg, consider dose increase 1, 2
- Maintenance treatment is typically needed for several months beyond acute response 1
Special Considerations
- For patients with concerns about taking an antidepressant, explain the mechanism of action and emphasize that sertraline is well-tolerated with fewer drug interactions than many other antidepressants 6
- Sertraline has a favorable safety profile in overdose compared to tricyclic antidepressants 4
- Advise patients that sertraline may initially improve anxiety symptoms before depressive symptoms 7
Common Pitfalls to Avoid
- Starting at too high a dose, which may increase side effects and reduce adherence 5
- Discontinuing treatment too early (before 6-8 weeks) due to perceived lack of efficacy 1
- Failing to warn patients about the delayed onset of antidepressant effect 6
- Not discussing potential sexual side effects, which can lead to non-adherence if patients are unprepared 3
- Stopping the medication abruptly rather than tapering when discontinuation is desired 3