Medication (generic)
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.
Prescribing
SSRI start
Common SSRI starting doses with titration and safety checks.
Last reviewed 2026-01-05|mental-health | depression | medication
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Dosing quick reference
Medication (generic)
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.
| Medication (generic) | Starting dose | Typical titration / target | Monitoring / notes |
|---|---|---|---|
| Sertraline | 25-50 mg once daily | Increase by 25-50 mg every 1-2 weeks to 50-150 mg | Watch for GI upset, activation, or insomnia early on. |
| Escitalopram | 5-10 mg once daily | Increase by 5-10 mg every 1-2 weeks to 10-20 mg | QTc risk at higher doses; use lower max in older adults. |
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.
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.