Starting Dose of Zoloft (Sertraline)
The recommended starting dose of sertraline for most adult indications is 50 mg once daily, with the exception of panic disorder, PTSD, and social anxiety disorder, which should start at 25 mg once daily for one week before increasing to 50 mg daily. 1
Adult Dosing by Indication
Major Depressive Disorder and Obsessive-Compulsive Disorder
- Start at 50 mg once daily 1
- This 50 mg dose represents both the starting dose and the usually effective therapeutic dose for most patients 2
- May be administered at any time of day (morning or evening) 1
Panic Disorder, PTSD, and Social Anxiety Disorder
- Start at 25 mg once daily 1
- After one week, increase to 50 mg once daily 1
- This lower initial dose helps minimize early treatment side effects in these anxiety-related conditions
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
Pediatric Dosing (Ages 6-17)
Obsessive-Compulsive Disorder
- Children (ages 6-12): Start at 25 mg once daily 1
- Adolescents (ages 13-17): Start at 50 mg once daily 1
- Lower body weights in children should be considered when advancing doses to avoid excess dosing 1
Dose Titration Principles
- Do not increase doses more frequently than weekly intervals due to sertraline's 24-hour elimination half-life 1
- Patients not responding to initial 50 mg dose may benefit from increases up to a maximum of 200 mg/day 1
- Dose increases should occur in 50 mg increments 1
- Steady-state plasma concentrations are reached after approximately 7 days 3
Special Population Considerations
Elderly Patients
- No dose reduction is necessary based solely on age 2, 4
- Start at the standard 50 mg dose for depression and OCD 1
- The pharmacokinetics in elderly patients are similar to younger adults, and sertraline is well-tolerated in this population 4
- Sertraline has advantages over other SSRIs in the elderly due to its low potential for drug interactions 4
Important Clinical Considerations
Common side effects to counsel patients about include sweating, tremors, nervousness, insomnia or somnolence, dizziness, gastrointestinal disturbances, and sexual dysfunction 5
Therapeutic plasma concentrations range from 10-50 ng/mL, with mean levels of approximately 12±17 ng/mL at 50 mg daily and 19±18 ng/mL at 100 mg daily 5
Drug interaction profile is favorable—sertraline has minimal inhibitory effects on major cytochrome P450 enzymes and fewer clinically significant drug interactions compared to other antidepressants 5, 6
Avoid common pitfalls: Do not advance doses too quickly (respect the one-week minimum interval), and do not assume elderly patients need lower doses—they tolerate standard dosing well 1, 4