What is the appropriate outpatient prescription for a patient with major depressive disorder, including medication name, dose, route, frequency, quantity, and refills?

Sertraline Prescription for Major Depressive Disorder

Initiate sertraline at 50 mg once daily, as this is the FDA-approved starting dose and optimal therapeutic dose for major depressive disorder in adults, with no titration required for most patients. 1

Complete Outpatient Prescription

Patient Name: [PATIENT]
Date of Birth: [DATE_OF_BIRTH]

Medication: Sertraline 50 mg tablets

Dose: Take 50 mg (one tablet) by mouth once daily

Route: Oral

Frequency: Once daily (may be taken in the morning or evening)

Quantity to Dispense: 30 tablets

Refills: 5 refills (to cover 6 months of continuation therapy)

Instructions: Take one tablet by mouth once daily at the same time each day. May be taken with or without food. Continue taking even if you feel better unless instructed otherwise by your provider.

Prescriber Signature: ________________________
Credentials: PMHNP Student
Date: ________________________

Rationale for Dosing Strategy

Initial Dose Selection

• Sertraline 50 mg once daily is the recommended starting dose for major depressive disorder and represents the optimal therapeutic dose for most patients. 1 The FDA label explicitly states that 50 mg daily is "recommended as the initial therapeutic dose" for MDD. 1

• No titration is required at initiation. Unlike panic disorder, PTSD, or social anxiety disorder (which start at 25 mg for one week), major depressive disorder treatment begins directly at 50 mg daily. 1

• This dose balances efficacy and tolerability. Clinical trials demonstrate that 50 mg once daily is as effective as higher dosages (100-200 mg) for treating major depression, with fewer side effects and lower discontinuation rates. 2

Dose Adjustment Algorithm

• Maintain 50 mg daily for at least 4-8 weeks before considering dose adjustment. Evidence shows substantial continued response rates when patients remain on 100 mg or less through week 8, even if initial response at week 6 was inadequate. 3

• If inadequate response after 2-4 weeks at 50 mg, increase to 100 mg daily. Patients not responding to 50 mg may benefit from dose increases up to a maximum of 200 mg/day. 1

• Dose changes should occur at intervals of no less than 1 week due to sertraline's 24-hour elimination half-life. 1

• Maximum dose is 200 mg daily. Doses should be increased in 50 mg increments weekly as needed. 1

Treatment Duration

• Continue treatment for at least 4-6 months after achieving response for a first episode of major depressive disorder. 4 The acute treatment phase lasts 6-12 weeks, followed by a continuation phase of 4-9 months. 4

• Patients with recurrent depression require prolonged maintenance treatment (≥1 year) to prevent recurrence. 4

Special Considerations

• No dosage adjustment needed based on age alone. Sertraline requires no dose modification in elderly patients solely due to age. 5, 6

• Sertraline has lower sexual dysfunction rates than paroxetine but similar rates to fluoxetine. 4 This should be discussed with patients when selecting among second-generation antidepressants.

• Monitor for treatment response using standardized tools such as the PHQ-9 or Hamilton Depression Rating Scale to quantify improvement (typically defined as ≥50% reduction in severity). 4

Safety Monitoring

• Common adverse effects include nausea, diarrhea, dry mouth, headache, insomnia, somnolence, dizziness, and sexual dysfunction. 4, 5, 6 These are usually mild and well-tolerated.

• Counsel patients and families about neuropsychiatric adverse effects, including suicidal thoughts, particularly in patients younger than 24 years. 4

• Sertraline has low potential for drug interactions at the cytochrome P450 enzyme level, making it advantageous in patients on multiple medications. 5, 6