What is the typical dosing regimen for Zoloft (sertraline)?

Zoloft (Sertraline) Dosing

For most adult indications, start sertraline at 50 mg once daily, which serves as both the initial and typically effective therapeutic dose, with dose increases up to 200 mg/day reserved for non-responders after at least 1 week at each dose level. 1

Adult Dosing by Indication

Major Depressive Disorder and Obsessive-Compulsive Disorder

• Initiate at 50 mg once daily 1
• This starting dose is the usually effective therapeutic dose for most patients 2
• For non-responders, increase in 50 mg increments up to a maximum of 200 mg/day 1
• Wait at least 1 week between dose changes due to sertraline's 24-hour elimination half-life 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
• Titrate up to 200 mg/day maximum for non-responders, with dose changes at minimum weekly intervals 1

Premenstrual Dysphoric Disorder (PMDD)

• Start at 50 mg/day 1
• Can be dosed either daily throughout the menstrual cycle OR limited to the luteal phase 1
• For continuous dosing: increase in 50 mg increments up to 150 mg/day 1
• For luteal phase dosing: maximum 100 mg/day, with a 50 mg/day titration step for 3 days at the beginning of each luteal phase 1

Pediatric Dosing (OCD Only)

• Children ages 6-12: Start at 25 mg once daily 1
• Adolescents ages 13-17: Start at 50 mg once daily 1
• Maximum dose: 200 mg/day for both age groups 1
• Consider lower body weights in children when advancing doses to avoid excess dosing 1

Administration Details

• Administer once daily, either morning or evening 1, 2
• Can be taken with or without food 1
• No dose adjustment needed for elderly patients based on age alone 2, 3

Key Clinical Pearls

Dose Titration Considerations

• Evidence suggests that dose escalation beyond 50 mg may not enhance efficacy for many patients 4
• A study of non-responders at 3 weeks found no significant difference between continuing 50 mg versus escalating to 150 mg 4
• However, some individual patients clearly benefit from higher doses up to 200 mg/day 1, 4

Maintenance Treatment

• For major depressive disorder, antidepressant efficacy is maintained for at least 44 weeks following initial response 1
• The dose needed for maintenance may be the same as the dose that achieved initial response 1
• Periodically reassess patients to determine ongoing need for treatment 1

Drug Interaction Advantage

• Sertraline has less effect on metabolism of other medications compared to other SSRIs, making it advantageous in polypharmacy situations common in elderly patients 5, 3