Maximum Sertraline Dose for a 17-Year-Old
The maximum recommended dose of sertraline for a 17-year-old is 200 mg per day, using the adolescent dosing protocol that starts at 50 mg once daily. 1
Dosing Protocol for Adolescents
- Starting dose: 50 mg once daily (morning or evening) for adolescents ages 13-17 years 1
- Titration: Increase in 50 mg increments at intervals of no less than 1 week, based on clinical response 1
- Maximum dose: 200 mg per day 1
The FDA label explicitly states that adolescents (ages 13-17) should follow this dosing schedule, which differs from younger children (ages 6-12) who start at 25 mg daily 1. The 24-hour elimination half-life of sertraline necessitates waiting at least one week between dose adjustments 1.
Evidence Supporting This Maximum Dose
- Clinical trials demonstrating sertraline's effectiveness in pediatric patients with OCD dosed participants in the range of 25-200 mg/day for ages 6-17 years 1
- A pharmacokinetic study confirmed that adolescents can safely receive up to 200 mg/day using the adult titration schedule, with similar drug exposure profiles to adults when normalized for body weight 2
- The landmark anxiety study in children and adolescents (ages 7-17) used sertraline doses up to 200 mg per day, demonstrating both efficacy and safety at this maximum dose 3
Critical Safety Considerations
Monitor closely for suicidal ideation, particularly in the first months of treatment and following dose increases, as SSRIs carry a boxed warning for increased suicidal thinking in patients under age 18 4. The pooled absolute risk is 1% for antidepressants versus 0.2% for placebo, yielding a number needed to harm of 143 4.
Watch for behavioral activation/agitation (restlessness, insomnia, impulsiveness, disinhibited behavior), which is more common in younger patients and may occur early in treatment or with dose increases 4. This supports the recommendation for slow titration and close monitoring 4.
Additional adverse effects to monitor include: dry mouth, nausea, diarrhea, headache, insomnia, dizziness, and sexual dysfunction (particularly relevant in adolescents) 4, 5.
Special Circumstances
- Off-label use for premature ejaculation: While guidelines mention sertraline 50-200 mg daily for this indication, they specifically caution about prescribing SSRIs to adolescents and note increased risk of suicidal ideation in patients under 18 4
- Anxiety disorders: The same 200 mg maximum applies, with demonstrated efficacy in separation anxiety, generalized anxiety, and social phobia 3
- No dose adjustment needed based solely on age when comparing adolescents to adults 2