Starting Dose of Zoloft (Sertraline)
The standard starting dose of sertraline is 50 mg once daily for major depressive disorder and obsessive-compulsive disorder, while panic disorder, PTSD, and social anxiety disorder should begin at 25 mg once daily for one week before increasing to 50 mg daily. 1
Standard Adult Dosing
- For Major Depressive Disorder and OCD: Start at 50 mg once daily, which serves as both the initial and typically effective therapeutic dose 1, 2
- For Panic Disorder, PTSD, and Social Anxiety Disorder: Begin at 25 mg once daily, then increase to 50 mg once daily after one week 1
- For Premenstrual Dysphoric Disorder: Start at 50 mg daily, either throughout the menstrual cycle or limited to the luteal phase 1
Pediatric Dosing (Ages 6-17)
- Children ages 6-12 with OCD: Start at 25 mg once daily 1
- Adolescents ages 13-17 with OCD: Start at 50 mg once daily 1
- Lower body weights in children should be considered when advancing doses to avoid excess dosing 1
Elderly Patients (≥60 Years)
- The American Academy of Family Physicians recommends starting at 25-50 mg once daily in elderly patients 3
- No dosage adjustment is required based solely on age, as sertraline is well-tolerated in this population 4, 5
- The 50 mg starting dose remains the optimal dose when considering both efficacy and tolerability 2
Dose Titration Guidelines
- Timing of dose changes: Do not increase the dose at intervals less than 1 week, given sertraline's 24-hour elimination half-life 1
- Dose escalation: For patients not responding to 50 mg daily, increase in 50 mg increments up to a maximum of 200 mg daily 1, 2
- Response assessment: Allow at least 2-4 weeks at each dose before determining effectiveness 2
Administration Considerations
- Sertraline may be administered once daily at any time of day (morning or evening) 1
- The medication can be taken with or without food 1
- The 50 mg starting dose is the usually effective therapeutic dose and optimal when balancing efficacy and tolerability for most patients 2
Common Pitfalls to Avoid
- Do not start elderly patients at lower doses solely based on age - unlike some SSRIs, sertraline does not require age-based dose reduction, though starting at 25 mg is reasonable for tolerability 3, 2, 5
- Do not increase doses too quickly - wait at least one week between dose changes to allow steady-state concentrations to be achieved 1
- Do not confuse indication-specific starting doses - anxiety disorders require 25 mg initially, while depression and OCD start at 50 mg 1