What is the typical dosage of sertraline (selective serotonin reuptake inhibitor - SSRI)?

Sertraline Dosing

For most adult patients with depression or OCD, start sertraline at 50 mg once daily, which serves as both the initial and typically effective therapeutic dose. 1

Adult Dosing by Indication

Major Depressive Disorder and Obsessive-Compulsive Disorder

• Starting dose: 50 mg once daily 1
• This initial dose is the usually effective therapeutic dose for most patients 2
• May be administered at any time of day (morning or evening) 1

Panic Disorder, PTSD, and Social Anxiety Disorder

• Starting dose: 25 mg once daily for the first week 1
• Increase to 50 mg once daily after one week 1
• This lower initial dose helps minimize early side effects in these anxiety-related conditions 1

Premenstrual Dysphoric Disorder (PMDD)

• Starting dose: 50 mg/day 1
• Can be dosed either daily throughout the menstrual cycle or limited to the luteal phase 1
• For luteal phase dosing, use a 50 mg/day titration step for three days at the beginning of each dosing period if escalating to 100 mg/day 1

Dose Escalation Strategy

If patients do not respond adequately to 50 mg/day within 2-4 weeks, increase the dose in 50 mg increments 3, 1

• Maximum dose: 200 mg/day 3, 1
• Minimum interval between dose changes: 1 week (due to sertraline's 24-hour elimination half-life) 1
• Dose increases should occur at no less than weekly intervals 1
• For PMDD with luteal phase dosing, maximum is 100 mg/day; for continuous dosing, maximum is 150 mg/day 1

Pediatric Dosing (Ages 6-17, OCD Only)

Children ages 6-12 years:

• Starting dose: 25 mg once daily 3, 1
• Consider lower body weights when advancing dose to avoid excess dosing 1

Adolescents ages 13-17 years:

• Starting dose: 50 mg once daily 3, 1

For both age groups:

• Maximum dose: 200 mg/day 1
• Increase dose at intervals of at least 1 week 1
• May be given morning or evening 1

Special Populations

Elderly Patients (≥60 years)

• No dosage adjustment needed based on age alone 1, 2
• Use the same starting dose of 50 mg/day as in younger adults 2
• Sertraline is well tolerated in elderly patients with a favorable side effect profile compared to tricyclic antidepressants 4
• The pharmacokinetics in elderly patients are similar to younger adults, eliminating the need for dose reduction 2

Renal Impairment

• No specific dosage adjustment mentioned in FDA labeling 1

Hepatic Impairment

• Use with caution; consider lower or less frequent dosing (though specific recommendations not provided in the evidence) 1

Maintenance Treatment Duration

Major Depressive Disorder:

• Continue treatment for several months or longer beyond initial response 1
• Efficacy demonstrated for up to 44 weeks following 8 weeks of initial treatment 1

PTSD:

• Requires several months or longer of sustained therapy 1
• Efficacy maintained for up to 28 weeks following 24 weeks of treatment 1

Social Anxiety Disorder:

• Chronic condition requiring several months or longer of therapy 1
• Efficacy maintained for up to 24 weeks following 20 weeks of treatment 1

OCD and Panic Disorder:

• Require several months or longer of sustained therapy beyond initial response 1

Discontinuation

Taper sertraline slowly when discontinuing to avoid withdrawal effects 3

• Abrupt discontinuation should be avoided 3
• Gradual dose reduction is recommended, though specific tapering schedules are not provided in the evidence 3

Key Clinical Pearls

• Monitor closely for clinical worsening, suicidality, and unusual behavior changes during the initial months of treatment or at times of dose changes 3
• Sertraline has minimal effects on cytochrome P450 enzymes, resulting in low potential for drug interactions compared to other SSRIs 3, 5
• Steady-state plasma concentrations are reached after approximately 7 days of once-daily dosing 6
• The 50 mg starting dose represents the optimal balance of efficacy and tolerability for most patients 2