What is the recommended starting dose, administration, and maximum dose of sertraline (Selective Serotonin Reuptake Inhibitor) for the treatment of Obsessive-Compulsive Disorder (OCD)?

Sertraline Dosing for OCD

Starting Dose

For adults with OCD, start sertraline at 50 mg once daily, taken either in the morning or evening. 1

• For children ages 6-12 years, start at 25 mg once daily 1
• For adolescents ages 13-17 years, start at 50 mg once daily 1
• Unlike panic disorder or PTSD (which start at 25 mg), OCD treatment begins at the higher 50 mg dose in adults 1

Dose Titration

Increase the dose in 50 mg increments at intervals of no less than 1 week, as the elimination half-life of sertraline is 24 hours. 1

• Patients not responding to 50 mg may benefit from dose increases 1
• For pediatric patients, advance doses cautiously considering their lower body weights to avoid excess dosing 1
• Clinical trials demonstrated effectiveness across a dosing range of 50-200 mg/day 1

Maximum Dose

The maximum recommended dose of sertraline for OCD is 200 mg once daily. 1

• This 200 mg maximum applies to both adults and pediatric patients (ages 6-17) 1
• Fixed-dose studies confirmed efficacy and safety at 50 mg, 100 mg, and 200 mg daily doses 2
• Higher doses are typically required for OCD compared to depression or anxiety disorders, with effective dosing ranging from 50-200 mg daily 3

Time to Response

Allow at least 8-12 weeks at the maximum tolerated dose to determine efficacy, though some improvement may begin within 2-4 weeks. 3

• The treatment algorithm from Nature Reviews Disease Primers recommends at least 8 weeks on the maximum recommended or tolerated dose before considering the trial inadequate 4
• Continued treatment beyond initial response can achieve further improvement in OCD symptoms 5

Maintenance Treatment

Continue treatment for a minimum of 12-24 months after achieving remission due to high relapse risk after discontinuation. 4, 3

• Systematic evaluation has not established whether the maintenance dose needs to be identical to the dose that achieved initial response 1
• Patients should be maintained on the lowest effective dose and periodically reassessed 1

Clinical Considerations

SSRIs like sertraline are first-line pharmacological treatment for OCD based on efficacy, tolerability, safety, and lack of abuse potential. 6, 3

• Sertraline demonstrates equivalent efficacy to clomipramine but with superior tolerability, resulting in better treatment adherence 3, 7
• In head-to-head comparison, sertraline had an 11% withdrawal rate due to adverse events versus 26% for clomipramine 7
• The most common adverse events with sertraline are diarrhea (12%) and nausea (12%) 7
• If inadequate response occurs after 8-12 weeks at maximum dose, consider switching to another SSRI, augmentation with CBT, or other strategies per the treatment algorithm 4, 3