Sertraline Starting Dose for Anxiety
For adults with anxiety disorders (panic disorder, PTSD, social anxiety disorder), start sertraline at 25 mg once daily for one week, then increase to 50 mg once daily. 1
Adult Dosing Strategy
The FDA-approved starting dose for anxiety disorders in adults is 25 mg once daily, increased to 50 mg daily after one week. 1 This differs from depression, where the starting dose is 50 mg daily. 1
Key Dosing Parameters
- Initial dose: 25 mg once daily for 7 days 1
- Standard therapeutic dose: 50 mg once daily (after the first week) 1
- Dose range: 50-200 mg/day based on clinical trials 1
- Titration interval: No more frequently than weekly, given sertraline's 24-hour elimination half-life 1
When to Consider Lower Starting Doses
Consider starting even lower than 25 mg (a subtherapeutic "test" dose) in patients prone to anxiety or agitation, as SSRIs can paradoxically worsen these symptoms initially. 2, 3 This is particularly important because initial adverse effects of SSRIs can include anxiety or agitation. 2
Pediatric Dosing (Ages 6-17)
For children and adolescents with anxiety disorders:
- Children (6-12 years): Start at 25 mg once daily 3, 1
- Adolescents (13-17 years): Start at 50 mg once daily 3, 1
- Parental oversight of medication regimens is paramount 2, 3
Titration and Dose Optimization
Increase dose in 50 mg increments at approximately 1-2 week intervals if needed, up to a maximum of 200 mg/day. 1, 3 Faster up-titration may be indicated for more severe anxiety presentations, though higher doses are associated with more adverse effects. 2, 3
Response Timeline
- Statistically significant improvement: May occur within 2 weeks 3
- Clinically significant improvement: Typically by week 6 3
- Maximal improvement: By week 12 or later 3
This timeline supports slow up-titration to avoid exceeding the optimal dose. 3
Administration Considerations
- Timing: Can be administered at any time of day (morning or evening) 1, 3
- Frequency: Once daily dosing is standard; at low doses, some patients may require twice-daily dosing 3
- Hepatic impairment: Reduced dose recommended 3
- Renal impairment: No dose adjustment needed 3
Critical Safety Warnings
Never combine sertraline with MAOIs due to serotonin syndrome risk; allow at least 14 days between discontinuing an MAOI and starting sertraline. 3
Monitor closely for suicidal thinking and behavior, especially in the first months of treatment and following dosage adjustments (pooled absolute rate: 1% for antidepressants versus 0.2% for placebo). 3
Do not abruptly discontinue sertraline, as it is associated with discontinuation syndrome characterized by dizziness, nausea, anxiety, and sensory disturbances; taper gradually. 2, 3
Common Drug Interactions
Sertraline may interact with:
- CYP2D6 substrates (sertraline inhibits this enzyme) 2, 4
- QT-prolonging medications 2
- Other serotonergic agents (increased serotonin syndrome risk) 3
Efficacy Evidence
Sertraline has demonstrated efficacy across multiple anxiety disorders at doses of 50-200 mg/day:
- Panic disorder: Effective at 50-175 mg/day, reducing panic attack frequency by 78-82% 5, 6
- Generalized anxiety disorder: Significantly superior to placebo with 63% response rate versus 37% for placebo 7
- Social anxiety disorder and PTSD: Effective in FDA-approved dose range 1
Confirm medication adherence before dose escalation, as non-adherence is a common reason for apparent treatment failure. 4