How Do You Increase Your Dose Of Zoloft?

In our latest question and answer, our pharmacist discusses strategies to decrease side effects when you increase the dose of Zoloft.

Question

I have been on 25mg of sertraline for 13 weeks. I feel like the medication may be 'just' holding me from having full anxiety or panic attacks, as I still get queasy in the belly, bit jittery, head fog in the morning, and sometimes when going places, feel sick (my trigger), or upcoming planned events. My doctor said to up my medication to 50mg if needed without asking her. Should I go straight to 50mg or is there a way to ease it in? My side effects when first starting sertraline was horrendous and I don't want to go through that again.

Asked by Glen On Oct 17, 2022

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Oct 17, 2022
Last updated Jul 18, 2024

Key points

  • Zoloft, an SSRI, is associated with several side effects, including nausea, diarrhea, insomnia, headache, weight changes, and sedation.
  • Side effects from Zoloft tend to be worse when the drug is first started, or when there is a dose increase, and often get better over time.
  • Increasing your dose of Zoloft can cause your initial side effects to return, and sources vary on the best approach to dose increases.
  • Increasing your dosage slowly, every one to four weeks, has been suggested and subsequently adjusting based on your response and how you are tolerating the medication.
  • Zoloft tablets can be split to make it easier to adjust your dose in smaller increments. There is a liquid version available as well.

Answer

Thanks so much for reaching out, great question!

It can be such a challenge to not only start an antidepressant like Zoloft (sertraline) due to the numerous side effects it can cause (more of which I detail below), but just as often, increasing your dose can be difficult since most side effects are 'dose-dependent' (i.e., increase in incidence and severity with higher doses).

In general, it is recommended to start at a low dose of Zoloft, and then dose adjustments are made according to several factors, including:

  • How you are responding to the medication
  • How you are tolerating the medication
  • Clinical urgency (i.e. severity of your condition)

For the treatment of depression, studies show the effective dose of Zoloft starts at 50mg per day (although your doctor may start you at a lower dose and titrate up to reduce side effects).

Common Zoloft Side Effects When Starting Or Increasing Your Dose

Several side effects are very common with SSRI (selective serotonin reuptake inhibitors) drugs, such as Zoloft, when either starting or increasing your dose. They are often demonstrated with the acronym FINISH:

  • Flu-like symptoms:
  • Insomnia
  • Neurologic effects
  • Imbalance
  • Sensory Disturbances
  • Hyperarousal

Other common side effects of SSRIs include:

  • Nausea (most common)
  • Dry mouth
  • Headache
  • Insomnia
  • Diarrhea
  • Sexual dysfunction
  • Somnolence
  • Sweating
  • Tremor
  • Weight change

Diarrhea is especially common with Zoloft, more so than other SSRIs.

SSRI side effects most often occur when treatment is first started, and they tend to decrease in severity over time (generally 1 to 3 months after starting). Additionally, they are dose-dependent, meaning higher doses tend to cause them more frequently and with more severity.

Due to this, it is recommended to start on a low dose, then slowly increase over time based on your response to the drug, and how you are tolerating it.

An important note here is that side effects with SSRIs can certainly occur anytime you increase your dose, even if you have been on the drug for a long period of time.

Recommendation On Increasing Your Zoloft Dose

There is no single definitive consensus on how exactly to increase your dose of Zoloft to greatest reduce your risk of side effects.

Although side effects that occur when increasing your dose tend to not be as bad as compared to when you are first starting therapy, they certainly can be troublesome to deal with, so a slow dose increase is generally recommended.

The prescribing information for Zoloft recommends starting the drug at a low dose and increasing it every week:

For adults and pediatric patients, subsequent dosages may be increased in case of an inadequate response in 25 to 50 mg per day increments once a week, depending on tolerability, up to a maximum of 200 mg per day.
Zoloft Prescribing Information

Other sources are more conservative.

UpToDate, a medical and pharmaceutical reference that publishes expert consensus, recommends increasing the dose of an SSRI every 1 to 4 weeks:

In the absence of intolerable side effects, a trial of two to six weeks (often four weeks) at the minimum therapeutic dose is often appropriate to assess response before adjusting the dose or implementing other treatment options. The dose can generally be increased every one to four weeks, depending upon response and tolerability.
UpToDate Selective serotonin reuptake inhibitors: Pharmacology, administration, and side effects

If you had particularly troublesome side effects when you started Zoloft, it would be more prudent to increase your dose slowly, and on the more conservative end.

Zoloft tablets can safely be cut or split to help you adjust by smaller dosage increments, and a liquid formulation of the drug is available as well which would help in this regard.

Additionally, although this is not an FDA-approved dosing regimen, some studies have found that splitting your dose of Zoloft and taking half in the morning and half in the evening, can sometimes reduce the severity of some side effects (although not all studies have found this to be true).

Be sure to talk to your doctor about what method of tapering is appropriate for you and your medical situation. 

Final Words

Since you mentioned in your question that you had significant trouble with side effects starting Zoloft 25mg, you may want to be more conservative in increasing your dose. Slowly increasing to 50mg (from 25mg) over a few weeks would likely reduce the risk and the severity of side effects.

One suggestion would be to increase to 37.5mg (one and one-half tablets of the 25mg), then wait 2-4 weeks before increasing again to 50mg. Please be sure to talk to your doctor and come up with a plan that is right for you, and a plan where you can be closely monitored.

If you do experience intolerable side effects at any point during your upward titration, you can absolutely decrease your dose to your last well-tolerated dose, and try your upwards titration again later, but more slowly.

I hope the information I provided here was helpful! Please reach back out again anytime!

References

  • Selective serotonin reuptake inhibitors: Pharmacology, administration, and side effects, UpToDate (Subscription Required)
  • Zoloft Prescribing Information, AccessFDA
  • Major Depressive Disorder Guidelines, Psychiatry Online
  • Sertraline pharmacokinetics and dynamics in adolescents, PubMed
  • Administration of antidepressants. Single versus split dosing: a meta-analysis, PubMed

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. Feel free to send him an email at [email protected]! You can also connect with Dr. Brian Staiger on LinkedIn.

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