Starting Dose of Zoloft (Sertraline) 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 once daily for one week, then increase to 50 mg once daily. 1
Standard Initial Dosing by Indication
Major Depressive Disorder and OCD
- Begin with 50 mg once daily 1
- This starting dose is 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 for the first week 1
- Increase to 50 mg once daily after one week 1
- This lower initial dose helps minimize activation symptoms in anxiety-prone patients 1
Premenstrual Dysphoric Disorder
- Begin with 50 mg daily, either throughout the menstrual cycle or limited to the luteal phase 1
Dose Titration Strategy
- Wait at least one week between dose adjustments due to sertraline's 24-hour elimination half-life 1
- For patients not responding to 50 mg, increase in 50 mg increments up to a maximum of 200 mg/day 1, 2
- Clinical trials demonstrating efficacy used doses ranging from 50-200 mg/day across all indications 1
- The 50 mg starting dose is effective for most patients without need for routine titration 2
Special Population Considerations
Pediatric Patients (OCD)
- Children ages 6-12: Start at 25 mg once daily 1
- Adolescents ages 13-17: Start at 50 mg once daily 1
- Consider lower body weight when advancing doses to avoid excess dosing 1
- Maximum dose: 200 mg/day 1
Elderly Patients
- No dosage adjustment needed based on age alone - use standard 50 mg starting dose 2, 3
- Sertraline 50-200 mg/day is effective and well-tolerated in patients ≥60 years 3
- Unlike other SSRIs, sertraline does not require altered dose recommendations in the elderly 2
Clinical Pearls and Timing
- Sertraline can be taken at any time of day (morning or evening), providing flexibility based on individual tolerability 1
- The most common adverse effects are gastrointestinal (nausea, diarrhea, dyspepsia), which are typically mild and transient 4
- Therapeutic response may be evident by week 3, with continued improvement through week 12 5
- Sertraline has a low potential for drug interactions compared to other SSRIs, making it particularly suitable for patients on multiple medications 3
Common Pitfall to Avoid
Do not increase the dose before one week has elapsed, as sertraline's 24-hour half-life requires adequate time to reach steady-state levels 1. Premature dose escalation increases the risk of side effects without improving efficacy and may lead to unnecessary discontinuation.