Dosing of Selective Serotonin Reuptake Inhibitors

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Sir: I am writing to address an inaccuracy written about thedosing and administration of selective serotonin reuptake inhibitor(SSRI) medications in the article by Marken and Munropublished in the December 2000 issue of the Companion.¹ Contraryto the contention by Drs. Marken and Munro that sertralineis more effective at the high end of the dosage range, the evidencesuggests that sertraline is effective at its minimum effectivedosage of 50 mg across the range of indicated mood andanxiety disorders and that, for patients not achieving optimalresponse, dose titration occurs among all SSRI agents.In the section on Dosing and Administration, there is only 1paragraph on the “dose-response” relationship and 1 referenceto support its only point for this section: “Recent data and widespreadclinical observation suggest that sertraline, unlike theother SSRIs, is more effective at the higher end of its dose rangethan at its recommended starting dose of 50 mg/day.”^1(p205)