Sertraline Dosing for PTSD
For Post-Traumatic Stress Disorder, start sertraline at 25 mg once daily for one week, then increase to 50 mg once daily, with a therapeutic range of 50-200 mg/day. 1
Initial Dosing Protocol
- Begin with 25 mg once daily for the first week to minimize initial side effects, particularly in PTSD patients who may be sensitive to activation 1
- After one week, increase to 50 mg once daily, which serves as the initial therapeutic dose 1
- Administer once daily, either morning or evening based on patient tolerance 1
Dose Titration Strategy
- Patients not responding to 50 mg may benefit from dose increases up to a maximum of 200 mg/day 1
- Do not change doses at intervals less than 1 week due to sertraline's 24-hour elimination half-life 1
- The clinical trials demonstrating efficacy used a dose range of 50-200 mg/day, with a mean effective dose around 70 mg/day 1, 2
- In the pivotal multicenter trial, flexible dosing between 50-200 mg/day resulted in a 60% responder rate versus 38% for placebo 2
Maintenance Treatment
- PTSD requires several months or longer of sustained pharmacological therapy beyond initial response 1
- Sertraline efficacy is maintained for periods up to 28 weeks following 24 weeks of initial treatment at doses of 50-200 mg/day 1
- Periodically reassess patients to determine ongoing need for maintenance treatment 1
- The dose needed for maintenance may be the same as that required for initial response, though this has not been definitively established 1
Common Pitfalls and Monitoring
- Insomnia is the most common adverse effect (35% vs 22% placebo), followed by diarrhea (28% vs 11%), nausea (23% vs 11%), fatigue (13% vs 5%), and decreased appetite (12% vs 1%) 2
- The discontinuation rate due to adverse events is low (9% for sertraline vs 5% for placebo) 2
- Significant improvement typically begins at week 2 and continues through week 12 3
- Sertraline demonstrates efficacy across all three PTSD symptom clusters: avoidance/numbing, hyperarousal, and reexperiencing 3