What is the recommended titration schedule for Sertraline (Zoloft)?

Sertraline (Zoloft) Titration Schedule

Start sertraline at 50 mg once daily for most adult indications (major depression, OCD), or 25 mg once daily for panic disorder, PTSD, and social anxiety disorder, then increase to 50 mg after one week. 1

Standard Titration Protocol

Initial Dosing by Indication

For Major Depressive Disorder and OCD:

• Begin at 50 mg once daily (morning or evening) 1
• This starting dose is typically the optimal therapeutic dose for most patients 2

For Panic Disorder, PTSD, and Social Anxiety Disorder:

• Start at 25 mg once daily 1
• After one week, increase to 50 mg once daily 1

For Pediatric OCD:

• Children (ages 6-12): Start at 25 mg once daily 1
• Adolescents (ages 13-17): Start at 50 mg once daily 1

Dose Escalation Strategy

If inadequate response after 2-4 weeks at 50 mg:

• Increase in 50 mg increments 2
• Wait at least 1 week between dose changes (due to sertraline's 24-hour elimination half-life) 1
• Maximum dose: 200 mg/day 1

The FDA label explicitly states that dose changes should not occur at intervals of less than 1 week, given sertraline's pharmacokinetics 1. Research confirms that 50 mg daily is the optimal dose when balancing efficacy and tolerability, with most patients not requiring higher doses 2.

Special Populations

Elderly Patients (≥60 years):

• No dosage adjustment needed based solely on age 3
• Use the same starting dose of 50 mg daily 3
• Sertraline has minimal anticholinergic effects and low drug interaction potential, making it particularly suitable for elderly patients 3

Premenstrual Dysphoric Disorder:

• Start at 50 mg/day, either daily throughout the menstrual cycle or limited to luteal phase 1
• If dosing during luteal phase and escalating to 100 mg/day, use a 50 mg/day titration step for 3 days at the beginning of each luteal phase 1

Critical Timing Considerations

Duration of adequate therapeutic trial:

• Allow 4-8 weeks at therapeutic dose before considering treatment failure 4
• Some patients may show continued improvement through week 8 even after initial non-response at week 6 5

When to increase dose:

• If no adequate response after 2-4 weeks at 50 mg, consider dose increase 2
• Research shows that continuing 100 mg/day sertraline resulted in 70% response rate in initial non-responders, while increasing to 200 mg/day resulted in only 56% response 5
• This suggests that extending treatment duration at 100 mg may be more effective than aggressive dose escalation 5

Common Pitfalls to Avoid

Do not increase doses too rapidly:

• The 24-hour half-life requires at least weekly intervals between changes 1
• Premature dose escalation before allowing adequate time at current dose may lead to unnecessary side effects 2

Do not assume higher doses are always better:

• Evidence suggests 50 mg is optimal for most patients 2
• Increasing from 100 mg to 200 mg may actually reduce response rates 5

Do not discontinue abruptly:

• Taper over 10-14 days to limit withdrawal symptoms 4

Maintenance Treatment

Once response is achieved, continue sertraline for several months or longer beyond the acute episode 1. Sertraline's antidepressant efficacy has been demonstrated for up to 44 weeks following initial 8-week treatment 1. Periodically reassess patients to determine ongoing need for maintenance treatment 1.