From the FDA Drug Label
Given the 24 hour elimination half-life of sertraline, dose changes should not occur at intervals of less than 1 week
- The recommended interval for dose changes is at least 1 week.
- Dose increases should not be made more frequently than every 7 days.
- This applies to all indications, including major depressive disorder, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, social anxiety disorder, and premenstrual dysphoric disorder 1.
From the Research
Zoloft (sertraline) doses should be increased gradually, with changes made no more frequently than once per week, starting at 25-50mg daily and increasing by 25-50mg increments weekly, as tolerated, until reaching the therapeutic dose (usually 50-200mg daily) 2. The most recent and highest quality study, a dose-response meta-analysis of randomized controlled trials published in 2023, found that the therapeutic response of sertraline for treating depression increased with the dosage, but the risk of total adverse reactions slightly decreased between 50 and 150 mg, and increased at doses above 150 mg 2.
Key Considerations
- The standard approach to increasing Zoloft doses is to start at a low dose and gradually increase as needed and as tolerated.
- Individual factors, such as age, weight, liver function, and concurrent medications, can affect how quickly doses can be safely increased.
- Some patients, particularly those with certain conditions like liver disease or the elderly, may require slower titration schedules.
- The body needs time to adjust to each dose level, and rushing increases can lead to more pronounced side effects without providing faster therapeutic benefits.
Important Findings
- A study published in 2001 found that the antidepressant effect of sertraline is not enhanced by dose titration, and that continued treatment with 50 mg dose of sertraline yields a rate of antidepressant response that is comparable to what is achieved by dose escalation from 50 mg to 150 mg of sertraline after 3 weeks of treatment 3.
- Another study published in 1995 found that the dose of sertraline can be increased in 50 mg/day increments at no less than weekly intervals to a maximum of 200 mg/day 4.
Recommendations
- Patients should never adjust their dose without consulting their healthcare provider.
- The dose of Zoloft should be increased gradually, with changes made no more frequently than once per week.
- The therapeutic dose of Zoloft is usually between 50-200mg daily, and the dose should be increased by 25-50mg increments weekly, as tolerated, until reaching the therapeutic dose.