Version July 2025
| SSRI | Starting dose (mg/day)* | Target dose (mg/day)¶ | Supratherapeutic doses (mg/day)Δ |
| Fluoxetine | 20 | 80 | >80 to 120 |
| Sertraline | 50 | 200 | >200 to 400 |
| Escitalopram◊ | 10 | 30 | >30 to 60 |
| Fluvoxamine | 50 | 300 | >300 to 450 |
| Paroxetine | 20 | 60 | >60 to 100 |
For use in conjunction with UpToDate content on the treatment of obsessive-compulsive disorder in adults. We check an electrocardiogram for changes in QT interval in all individuals treated with escitalopram ≥30 mg/day and any SSRI at supratherapeutic doses.
NOTE: Citalopram is not recommended because proarrhythmic effects may occur at higher doses.SSRI: selective serotonin reuptake inhibitor.
* A lower starting dose and slower titration are recommended in patients who are older (age >65 years) or medically compromised (eg, heart failure, kidney, or liver disease), or patients with panic disorder, medication anxiety, or known to be sensitive to drug side effects.
¶ We typically titrate at twice monthly intervals, as tolerated, to the target dose. However, the pace of titration depends on several factors (eg, side effects). If symptoms start improving at a lower dose, that dose can be tried for a longer time, and the target dose may not be needed.
Δ We gradually increase to supratherapeutic dose in patients who have not had an adequate response to a target dose of an SSRI. We proceed cautiously in older patients (age >65), if a supratherapeutic dose is needed. Refer to UpToDate for further discussion of supratherapeutic dosing, therapeutic trials, and adverse effects of SSRI medications.
◊ Due to cardiac conduction concerns, we do not use escitalopram in older individuals (age >65 years).