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DrSonia

SSRI start

Common SSRI starting doses with titration and safety checks.

Last reviewed January 5, 2026

Contraindications

  • Avoid combining with MAO inhibitors or other high-risk serotonergic combinations without specialist guidance.
  • Screen for bipolar spectrum risk before initiating monotherapy.
  • Reassess before restart when prior severe SSRI adverse reactions occurred.

Dosing

Sertraline

Starting dose
25-50 mg once daily
Typical titration / target
Increase by 25-50 mg every 1-2 weeks to 50-150 mg
Monitoring / notes
Watch for GI upset, activation, or insomnia early on.

Escitalopram

Starting dose
5-10 mg once daily
Typical titration / target
Increase by 5-10 mg every 1-2 weeks to 10-20 mg
Monitoring / notes
QTc risk at higher doses; use lower max in older adults.

Renal and hepatic considerations

  • Start lower and titrate more cautiously in significant hepatic impairment.
  • In renal impairment, review agent-specific dose limits and tolerability.
  • Reconcile interaction risks (including QT-prolonging combinations where relevant).

Pregnancy and lactation cautions

  • Discuss pregnancy plans and perinatal risk-benefit tradeoffs before initiation.
  • Use shared decision-making for medication choice and continuity during pregnancy.
  • During lactation, align SSRI selection with maternal response history and infant monitoring plans.

Monitoring checkpoints

  • Review suicide risk and activation symptoms within 1-2 weeks of start.
  • Counsel on delayed onset (2-4 weeks) and continuation for 6-12 months.
  • Track symptom trends using the same scale over time.

Stop or escalate criteria

  • Escalate urgently for active suicidality, emergent mania, or serotonin-toxicity concern.
  • Stop or adjust promptly when severe intolerable adverse effects develop.
  • Avoid abrupt discontinuation; taper when stopping unless urgent safety concerns require immediate change.

References

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