Sertraline Dosing for Hoarding Disorder
Start sertraline at 50 mg daily and titrate up to 200 mg daily as needed, as compulsive hoarding responds as well to SSRI treatment as other OCD symptoms.
Initial Dosing Strategy
- Begin with 50 mg once daily, which is the standard starting dose for sertraline in OCD-spectrum disorders 1, 2
- Sertraline can be administered at any time of day as a single daily dose 3
- No dose adjustment is needed for elderly patients 3
Titration Protocol
- Increase by 50 mg increments at weekly intervals if inadequate response after 2-4 weeks 3
- The therapeutic range for hoarding disorder is 50-200 mg daily, consistent with OCD treatment 1, 2
- Maximum dose is 200 mg daily 4, 2
- All three fixed doses (50,100, and 200 mg/day) have demonstrated efficacy in OCD, with the 50 mg and 200 mg doses showing the most consistent benefit 2
Evidence for Hoarding-Specific Response
Compulsive hoarders respond equally well to SSRI treatment as non-hoarding OCD patients, with hoarding symptoms improving as much as other OCD symptoms 5. In a study using paroxetine (a similar SSRI), both groups showed nearly identical improvement rates with no significant differences in treatment completion or response rates 5.
Duration of Adequate Trial
- Allow 8-12 weeks at therapeutic dose before determining treatment failure 1, 2
- The first study showed efficacy at 8 weeks, while the second demonstrated continued improvement through 12 weeks of treatment 1
Monitoring and Safety
- Monitor for suicidal thinking and behavior, especially in the first months of treatment and following dosage adjustments 6
- Common side effects include nausea, dry mouth, drowsiness, reduced libido, headache, insomnia, and dizziness 6
- Adverse effects appear dose-related but are generally well-tolerated 2
- Avoid abrupt discontinuation—taper gradually to prevent withdrawal syndrome (dizziness, fatigue, headaches, nausea, insomnia, sensory disturbances, anxiety) 6
Key Clinical Considerations
- Sertraline has a favorable drug interaction profile compared to other SSRIs due to less effect on CYP450 enzymes 6
- Never combine with MAOIs due to serotonin syndrome risk 6
- Higher doses may increase efficacy but could be associated with increased sexual side effects (erectile dysfunction, decreased libido) 6