From the Guidelines
The typical starting dose of sertraline for adults with depression or anxiety disorders is 50 mg once daily, but it can be started at a lower dose of 25 mg daily for sensitive patients or those with certain medical conditions, as evidenced by 1 and supported by the general principles of minimizing side effects and maximizing tolerability. This medication is usually taken in the morning or evening with or without food. Starting at a lower dose helps minimize initial side effects like nausea, headache, and insomnia that can occur when beginning treatment. For some patients, particularly the elderly, those with liver disease, or those who are sensitive to medications, doctors may start with 25 mg daily and gradually increase. After 1-2 weeks at the starting dose, if needed and tolerated, the dose can be increased gradually in 50 mg increments at intervals of at least one week, up to a maximum of 200 mg daily, as indicated by 1. Sertraline typically takes 2-4 weeks to show therapeutic effects, so patience is important when beginning treatment, and this timeline is consistent with the pharmacodynamic profile described in 1, which suggests a logarithmic model of response with significant improvement by week 6 and maximal improvement by week 12 or later. Patients should not stop taking sertraline suddenly as this can cause withdrawal symptoms; any discontinuation should be done gradually under medical supervision, highlighting the importance of careful management and monitoring as outlined in 1. It's also crucial to consider the potential side effects and interactions, including the risk of suicidal thinking and behavior, behavioral activation/agitation, and serotonin syndrome, as discussed in 1, to ensure safe and effective treatment. Given the most recent and highest quality evidence from 1, which provides comprehensive guidance on the assessment and treatment of children and adolescents with anxiety disorders, including the use of SSRIs like sertraline, the recommendation for starting sertraline at 50 mg once daily, with the option to start lower at 25 mg for sensitive populations, is supported by the latest clinical practice guidelines and evidence-based practices.
From the FDA Drug Label
Consequently, a dose of 50 mg, administered once daily, is recommended as the initial therapeutic dose. Sertraline treatment should be initiated with a dose of 50 mg/day, either daily throughout the menstrual cycle or limited to the luteal phase of the menstrual cycle, depending on physician assessment Sertraline treatment should be initiated with a dose of 25 mg once daily in children (ages 6 to 12) and at a dose of 50 mg once daily in adolescents (ages 13 to 17)
The starting dose of sertraline is:
- 50 mg/day for adults
- 25 mg/day for children (ages 6 to 12)
- 50 mg/day for adolescents (ages 13 to 17) 2
From the Research
Sertraline Starting Dose
- The starting dose of sertraline is typically 50 mg/day, as established in the treatment of depression 3.
- This dose is considered the usually effective therapeutic dose and the optimal dose when considering both efficacy and tolerability for most patients 3.
- For patients who do not show an adequate therapeutic response within 24 weeks, the dose of sertraline can be increased in 50 mg/day increments at no less than weekly intervals to a maximum of 200 mg/day 3.
- In primary care, patients received one capsule (sertraline 50 mg or placebo orally) daily for one week then two capsules daily for up to 11 weeks, consistent with evidence on optimal dosages for efficacy and acceptability 4.
Dosage Considerations
- There is no need for altered dose recommendations in the elderly when using sertraline 3.
- Higher doses of SSRIs, including sertraline, are associated with significantly greater symptom improvement and likelihood of treatment response, but also with an increased likelihood of dropout due to side effects 5.
- The efficacy and tolerability of sertraline in individuals with comorbid physical conditions have been assessed, and it has been found to be effective, although tolerability is a relevant concern 6.