Duration of Sertraline Treatment
For depression and anxiety disorders, continue sertraline for a minimum of 12-24 months after achieving remission, with many patients requiring indefinite treatment to prevent relapse. 1, 2
Acute Treatment Phase
The initial treatment period requires 8-12 weeks to determine efficacy, though some improvement may be observed within 2 weeks 1. For anxiety disorders specifically, the response follows a logarithmic model with:
- Statistically significant improvement by week 2 1
- Clinically significant improvement by week 6 1
- Maximal improvement by week 12 or later 1
For depression, systematic evaluation has demonstrated maintained antidepressant efficacy for up to 44 weeks following the initial 8-week treatment period 2.
Maintenance/Continuation Treatment Duration
Depression
Continue treatment for several months or longer beyond the acute response 2. The FDA label specifically states that acute episodes of major depressive disorder require several months or longer of sustained pharmacologic therapy beyond response to the acute episode 2. For chronic depression (≥2 years duration), patients who achieve remission with 12 weeks of sertraline maintain that remission during 16 weeks of continuation treatment in over two-thirds of cases 3.
Anxiety Disorders
- Panic Disorder and OCD: Continue for several months or longer beyond initial response 2. Systematic evaluation demonstrates maintained efficacy for up to 28 weeks following 24-52 weeks of initial treatment 2
- PTSD: Maintain treatment for several months or longer beyond initial response, with demonstrated efficacy for up to 28 weeks following 24 weeks of initial treatment 2
- Social Anxiety Disorder: This is a chronic condition requiring several months or longer of sustained therapy, with maintained efficacy demonstrated for up to 24 weeks following 20 weeks of initial treatment 2
Premature Ejaculation
Therapy will most likely be needed on a continuing basis 1. There is no clear consensus on whether sertraline will eventually cure premature ejaculation, allowing discontinuation, or whether lifelong treatment is required 1. Clinical experience indicates that premature ejaculation usually returns upon discontinuing therapy 1.
Risk of Relapse Upon Discontinuation
Relapse risk is substantial when antidepressants are discontinued prematurely 1. A meta-analysis of 31 randomized trials supports continuation of antidepressant therapy to reduce relapse risk 1. The recommended minimum maintenance duration is 12-24 months after achieving remission, though longer treatment may be necessary in many patients due to relapse risk 1.
Important Caveats
- Discontinuation syndrome can occur with sertraline, characterized by dizziness, fatigue, nausea, sensory disturbances, and anxiety 1. This is more common with shorter-acting SSRIs like paroxetine but can occur with sertraline 1
- Periodic reassessment is essential to determine ongoing need for maintenance treatment and to maintain patients on the lowest effective dose 2
- For pediatric patients with OCD, the same principles apply regarding maintenance treatment duration 2
- The elimination half-life of sertraline is approximately 22-36 hours (or 26-32 hours in other studies), making once-daily dosing appropriate 4, 5, 6