What is the starting dose of Sertraline (Selective Serotonin Reuptake Inhibitor) for adults?

Starting Dose of Sertraline for Adults

The starting dose of sertraline for adults is 50 mg once daily for major depressive disorder and obsessive-compulsive disorder, while panic disorder, posttraumatic stress disorder, and social anxiety disorder should begin at 25 mg once daily for one week before increasing to 50 mg once daily. 1

Standard Dosing by Indication

Major Depressive Disorder and OCD

• Initiate treatment at 50 mg once daily 1
• This starting dose is also the usually effective therapeutic dose and represents the optimal balance of efficacy and tolerability for most patients 2
• May be administered at any time of day (morning or evening) 1

Panic Disorder, PTSD, and Social Anxiety Disorder

• Start at 25 mg once daily 1
• After one week, increase to 50 mg once daily 1
• The lower initial dose helps minimize activation symptoms common with these anxiety disorders 1

Premenstrual Dysphoric Disorder

• Begin at 50 mg daily, either throughout the menstrual cycle or limited to the luteal phase 1
• Can increase in 50 mg increments at the onset of each new menstrual cycle if needed 1

Dose Titration Guidelines

• Patients not responding to 50 mg may benefit from dose increases up to a maximum of 200 mg/day 1
• Given sertraline's 24-hour elimination half-life, dose changes should not occur at intervals of less than 1 week 1
• Dose increases should be made in 50 mg increments 1

Special Population Considerations

Elderly Patients (≥60 years)

• No dosage adjustment is warranted based on age alone 3, 4
• The same starting dose of 50 mg once daily is appropriate 3, 4
• This contrasts with other SSRIs and represents a practical advantage in geriatric populations 4
• Sertraline lacks the marked anticholinergic effects of tricyclic antidepressants, making it particularly suitable for elderly patients who are prone to these adverse effects 3, 4

Pediatric Patients (OCD only)

• Children ages 6-12: Start at 25 mg once daily 1
• Adolescents ages 13-17: Start at 50 mg once daily 1
• Lower body weights should be considered when advancing doses to avoid excess dosing 1

Clinical Advantages of the 50 mg Starting Dose

• The 50 mg dose represents the optimal therapeutic dose when considering both efficacy and tolerability 2
• Sertraline has minimal inhibitory effects on major cytochrome P450 enzymes, resulting in fewer drug-drug interactions compared to other SSRIs 5
• The maximum recommended dose remains 200 mg per day across all indications 5, 1

Common Pitfalls to Avoid

• Do not increase the dose more frequently than weekly intervals, as this does not account for sertraline's pharmacokinetics and may increase side effects 1
• Do not start at lower doses in elderly patients solely based on age, unlike recommendations for some other antidepressants 3, 4
• For anxiety disorders, do not skip the initial 25 mg week, as starting directly at 50 mg may cause excessive activation or anxiety worsening 1

Tolerability Profile

• Common side effects include sweating, tremors, nervousness, insomnia or somnolence, dizziness, gastrointestinal disturbances, and sexual dysfunction 5
• The tolerability profile is generally similar between younger and elderly patients 3, 4
• Most frequently reported adverse events in elderly patients include dry mouth, headache, diarrhea, nausea, insomnia, somnolence, constipation, dizziness, sweating, and taste abnormalities 3, 4