What is the recommended dose of sertraline (Zoloft) for adults?

Sertraline Dosing for Adults

For major depressive disorder and obsessive-compulsive disorder, start sertraline at 50 mg once daily; for panic disorder, PTSD, and social anxiety disorder, start at 25 mg daily for one week, then increase to 50 mg daily. 1

Initial Dosing by Indication

Major Depressive Disorder and OCD

• Begin with 50 mg once daily as both the starting and initial therapeutic dose 1
• This dose is optimal when considering both efficacy and tolerability for most patients 2
• Can be administered at any time of day (morning or evening) 1

Panic Disorder, PTSD, and Social Anxiety Disorder

• Start at 25 mg once daily for the first week 1
• Increase to 50 mg once daily after one week 1
• The lower starting dose helps minimize initial side effects in these anxiety-related conditions 1

Premenstrual Dysphoric Disorder

• Begin with 50 mg daily, either throughout the menstrual cycle or limited to the luteal phase 1
• If using luteal phase dosing and establishing 100 mg/day, use a 50 mg/day titration step for three days at the beginning of each luteal phase 1

Dose Titration and Maximum Dosing

• For patients not responding to 50 mg daily, increase in 50 mg increments up to a maximum of 200 mg daily 3, 1
• Do not change doses more frequently than once weekly due to sertraline's 24-hour elimination half-life 1
• The dose range of 50-200 mg/day was used in clinical trials demonstrating effectiveness 1

Special Considerations

Medication-Sensitive Patients

• The 25 mg dose may be particularly valuable for patients who are more sensitive to medication side effects or taking multiple medications 4
• This lower starting dose can improve tolerability while still achieving therapeutic benefit 4

Elderly Patients

• No dosage adjustment is needed based solely on age 5, 6
• The same dosing recommendations apply to elderly patients as to younger adults 5, 6
• Sertraline has a favorable profile in the elderly due to minimal anticholinergic effects and low drug interaction potential 5, 6

Critical Safety Considerations

Discontinuation

• Never discontinue sertraline abruptly; taper gradually over 10-14 days to limit withdrawal symptoms 3, 4
• This is essential to prevent discontinuation syndrome 3, 4

Monitoring Requirements

• Monitor closely for clinical worsening, suicidality, and unusual behavior changes, especially during initial months of therapy or at times of dose changes 4
• This is particularly important in the first few weeks of treatment 4

Drug Interactions

• When using sertraline with cholestyramine, space doses a minimum of four hours apart to prevent binding and loss of efficacy 4
• Sertraline has less effect on metabolism of other medications compared to other SSRIs, making it advantageous in polypharmacy situations 3, 7