Escitalopram 20mg Daily is Equivalent to Sertraline 200mg Daily
For a patient taking sertraline 200mg daily, the equivalent dose of escitalopram (Lexapro) is 20mg daily, which represents the maximum recommended dose for both medications. 1
Evidence-Based Dose Equivalency
The most rigorous systematic analysis of antidepressant dose equivalency examined 83 randomized controlled trials with 14,131 participants and calculated that sertraline 98.5mg/day is equivalent to escitalopram 18.0mg/day when both are compared to a fluoxetine 40mg/day standard. 1 Using this ratio:
- Sertraline 200mg ÷ 98.5mg = 2.03
- Escitalopram 18.0mg × 2.03 = 36.5mg equivalent
However, this calculated dose exceeds the maximum recommended escitalopram dose.
Critical Dosing Limitations
The maximum recommended daily dose of escitalopram is 20mg, as higher doses are associated with QT prolongation and cardiac risks without additional therapeutic benefit. 2 This represents an important safety ceiling that cannot be exceeded regardless of theoretical dose equivalency calculations.
- The standard therapeutic range for escitalopram is 10-20mg daily for most adult patients 3
- Escitalopram 20mg is the effective dose for severe depression, while 10mg is optimal for moderate depression 4
- Sertraline's maximum dose is 200mg daily, with 50mg as the typical starting and often effective therapeutic dose 5
Clinical Implications for Switching
When converting from sertraline 200mg to escitalopram, you should prescribe escitalopram 20mg daily, recognizing that:
- This represents the maximum safe dose of escitalopram despite being a lower mathematical equivalent 2
- The patient is on a high dose of sertraline (200mg is the maximum), suggesting either severe symptoms or treatment resistance
- If the patient does not respond adequately to escitalopram 20mg after 6-8 weeks, consider switching to an SNRI (venlafaxine or duloxetine) rather than attempting to exceed the escitalopram maximum dose 2
Important Monitoring Considerations
- Allow 6-8 weeks at escitalopram 20mg before declaring treatment failure, as full antidepressant response requires adequate time at therapeutic dose 2
- Monitor for QT prolongation risk, particularly at the 20mg dose 2
- Assess for discontinuation symptoms from sertraline during the switch, including dizziness, fatigue, headaches, nausea, and anxiety 3
- Escitalopram has a 27-33 hour half-life and reaches steady state in 7-10 days, supporting once-daily dosing 6
Common Pitfall to Avoid
Do not attempt to prescribe escitalopram doses above 20mg daily in an effort to match the high sertraline dose mathematically—this increases cardiac risk without evidence of additional benefit and violates FDA-approved maximum dosing. 2