Sertraline Dosage for OCD
For adults with OCD, start sertraline at 50 mg once daily and titrate up to 150-200 mg daily, as higher doses are mandatory for OCD efficacy compared to depression treatment. 1, 2
Starting Dose and Titration
- Initiate treatment at 50 mg once daily (morning or evening), as specified in the FDA label for adult OCD patients 2
- Increase the dose gradually at intervals of no less than 1 week due to sertraline's 24-hour elimination half-life 2
- The maximum FDA-approved dose is 200 mg daily for OCD 2
Target Therapeutic Dose
- The effective dosing range for OCD is 150-200 mg daily, which is substantially higher than doses used for depression or other anxiety disorders 3, 1
- Clinical trials demonstrating efficacy used doses of 50-200 mg/day, with mean doses for completers ranging from 145-186 mg/day 2
- Fixed-dose studies showed that both 50 mg and 200 mg daily produced significant symptom reduction, though higher doses may offer additional benefit 2, 4
Timeline for Response Assessment
- Allow 8-12 weeks at the maximum tolerated dose before declaring treatment failure, as maximal improvement typically occurs by week 12 or later 3, 1
- Early response by weeks 2-4 predicts ultimate treatment success 3
- Significant improvement may first become apparent by week 3, with continued gains through week 12 5
Special Dosing Considerations
- For treatment-resistant patients who fail to respond to 200 mg daily after 16 weeks, consider increasing to 250-400 mg daily (off-label), which has shown significantly greater symptom improvement compared to continuing at 200 mg 6
- This high-dose strategy (mean dose 357 mg) demonstrated similar safety profiles to standard dosing in clinical trials 6
Maintenance Treatment
- Continue treatment for a minimum of 12-24 months after achieving remission due to the high risk of relapse after discontinuation 3, 1
- Sertraline demonstrated significantly lower relapse rates during 28-week continuation compared to placebo 3
Pediatric Dosing (Ages 6-17)
- Start at 25 mg once daily for children ages 6-12 2
- Start at 50 mg once daily for adolescents ages 13-17 2
- Titrate up to a maximum of 200 mg daily as tolerated, considering lower body weights in children to avoid excess dosing 2
Critical Clinical Pearls
- SSRIs are first-line pharmacological treatment for OCD based on efficacy, tolerability, safety, and lack of abuse potential 1
- If inadequate response occurs after 8-12 weeks at maximum dose, consider switching to another SSRI or augmentation with cognitive-behavioral therapy with exposure and response prevention (ERP), which has larger effect sizes than medication alone 3, 1
- Sertraline showed superior tolerability compared to clomipramine, with significantly fewer withdrawals due to adverse events (11% vs 26%) 7