Continue Sertraline at 100mg and Reassess at 6-8 Weeks
Since you are only on day 12 of sertraline 100mg, you should continue the current dose and allow adequate time for full antidepressant response, as improvement in depressive symptoms typically lags behind anxiety improvement and may not be evident until 5-8 weeks of treatment. 1, 2
Why Your Current Situation is Expected
- Sertraline shows beneficial effects on anxiety symptoms as early as 2 weeks of treatment, but effects on core depressive symptoms (including low mood) often emerge more slowly. 3
- The American College of Physicians guidelines specify that you need 6-8 weeks of treatment before determining if you have an adequate response to pharmacotherapy for depression. 1
- Clinical improvement may not be evident until 5 weeks or longer, with maximal benefit potentially delayed until 12 weeks of treatment. 2
What You Should Do Now
Continue your current 100mg dose without changes and maintain close monitoring with your prescriber. 1
Monitoring Schedule
- You should be assessed by your clinician within 1-2 weeks of starting treatment (which you've already passed) and then regularly thereafter. 1
- Your prescriber should monitor for worsening depression, emergence of agitation, irritability, or unusual behavioral changes, as these can indicate worsening depression. 1
- The risk for suicide attempts is greater during the first 1-2 months of treatment, requiring close monitoring. 1
Timeline for Decision-Making
- If your mood symptoms have not adequately improved by week 6-8, your clinician should modify your treatment. 1
- At that point, options include switching to a different antidepressant, adding augmentation therapy, or adding psychotherapy if not already included. 1
Consider Adding Cognitive Behavioral Therapy
If you are not already receiving CBT, adding it to your medication regimen should be strongly considered, as combination treatment (CBT + SSRI) is superior to medication alone for treating depression and anxiety. 1, 2
- Combination treatment improves response rates, remission rates, and global functioning compared to sertraline alone. 1
- Adding CBT should be considered before or concurrent with any dose escalation. 2
Important Caveats
- Higher doses of sertraline are not clearly associated with greater magnitude of response and can be associated with more adverse effects. 2
- Since you're already on 100mg (a therapeutic dose), the focus should be on allowing adequate time rather than increasing the dose prematurely. 4, 5
- Sertraline is effective for treating both depression and anxiety, with proven efficacy across multiple studies, so your current medication choice is appropriate. 6, 5
- In patients with chronic depression and concurrent anxiety, sertraline has been shown to effectively treat both symptom clusters, though anxiety may improve first. 7