Best Starting Dose for Zoloft (Sertraline)
The best starting dose for Zoloft is 50 mg once daily for major depressive disorder and obsessive-compulsive disorder, while panic disorder, PTSD, and social anxiety disorder should start at 25 mg once daily for one week before increasing to 50 mg daily. 1
Initial Dosing by Indication
Major Depressive Disorder and OCD
- Start with 50 mg once daily as this represents both the initial and typically effective therapeutic dose 1
- This 50 mg starting dose is optimal when balancing efficacy and tolerability for most patients 2
- No dose adjustment is needed based solely on age, including elderly patients 1, 3
Panic Disorder, PTSD, and Social Anxiety Disorder
- Begin at 25 mg once daily for the first week, then increase to 50 mg once daily 1
- This lower initial dose helps minimize early treatment side effects in these anxiety-related conditions 1
Premenstrual Dysphoric Disorder
- Start at 50 mg daily, either throughout the menstrual cycle or limited to the luteal phase 1
- If using luteal phase dosing and a 100 mg dose is established, use a 50 mg titration step for three days at the beginning of each dosing period 1
Timing and Administration
- Sertraline can be taken either morning or evening with no difference in efficacy 1, 2
- Administer as a single daily dose 1
Dose Titration Strategy
- Wait at least one week between dose changes 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 daily 1, 2
- Clinical response may take 4-8 weeks to fully manifest, so avoid premature dose escalation 4
Pediatric Dosing (Ages 6-17, OCD Only)
- 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 weights when advancing doses to avoid excess dosing 1
Key Clinical Considerations
- The 50 mg starting dose is the usually effective therapeutic dose for depression and OCD, making it both the starting point and target dose for most patients 2
- Sertraline has minimal effects on cytochrome P450 enzymes, resulting in fewer drug interactions compared to other SSRIs 5, 6, 3
- Common side effects include nausea, diarrhea, headache, insomnia, and dry mouth, but the drug lacks the anticholinergic effects of tricyclic antidepressants 3, 7
- Elderly patients tolerate sertraline similarly to younger adults and require no age-based dose adjustments 8, 3