Sertraline Dosing for OCD
For adults with OCD, start sertraline at 50 mg once daily and titrate up to a maximum of 200 mg/day as needed, with dose adjustments made no more frequently than weekly; for children ages 6-12 start at 25 mg daily, and for adolescents ages 13-17 start at 50 mg daily, with the same maximum dose of 200 mg/day. 1
Adult Dosing
- Initial dose: 50 mg once daily (morning or evening) 1
- Therapeutic range: 50-200 mg/day with most patients requiring doses toward the higher end of this range 1
- Titration schedule: Increase dose in patients not responding to 50 mg, up to maximum 200 mg/day 1
- Timing of dose adjustments: Given sertraline's 24-hour elimination half-life, dose changes should occur no more frequently than at 1-week intervals 1
Pediatric Dosing (Ages 6-17)
- Children (6-12 years): Start at 25 mg once daily 1
- Adolescents (13-17 years): Start at 50 mg once daily 1
- Maximum dose for both groups: 200 mg/day 1
- Important consideration: Lower body weights in children should be factored into dose advancement to avoid excess dosing 1
- Titration interval: Same as adults—no more frequently than weekly 1
Key Dosing Principles for OCD
Higher doses are typically required for OCD compared to depression or other anxiety disorders, and these higher doses are associated with greater treatment efficacy but also increased adverse effects 2, 3
- Clinical trials demonstrating sertraline's effectiveness in OCD used doses ranging from 50-200 mg/day, with mean doses for completers around 145-186 mg/day 1
- The mean dose in pediatric OCD studies was 178 mg/day 1
Treatment Timeline and Response
- Trial duration: Allow 8-12 weeks to determine efficacy 3
- Response pattern: Significant improvement may be observed within the first 2 weeks, with clinically significant improvement by week 6 and maximal improvement by week 12 or later 3
- Maintenance treatment: After achieving remission, continue for a minimum of 12-24 months; many patients require longer treatment due to high relapse risk after discontinuation 3
Monitoring and Adverse Effects
Common side effects include dry mouth, nausea, diarrhea, headache, somnolence, insomnia, dizziness, and sexual dysfunction 3
Serious adverse effects requiring monitoring:
- Suicidal thinking (especially in first months and after dose adjustments) 3
- Behavioral activation/agitation (may occur early in treatment or with dose increases) 3
- Serotonin syndrome, hypomania, seizures, abnormal bleeding 3
Treatment Resistance Options
If inadequate response to sertraline after an adequate trial:
- Switch to another SSRI 3
- Try clomipramine 3
- Augment with antipsychotics or glutamatergic agents 3
- Add cognitive-behavioral therapy (CBT) if not already implemented 3
- Combining sertraline with CBT may provide additional benefit for patients with inadequate response to either treatment alone 2, 3
Special Populations
Elderly patients: Sertraline clearance is approximately 40% lower; steady-state achieved after 2-3 weeks rather than 1 week 1
Hepatic impairment: Use lower or less frequent dosing in patients with liver disease due to reduced clearance (approximately 3-fold greater exposure in mild impairment) 1
Renal impairment: No dose adjustment needed; pharmacokinetics unaffected by renal impairment 1