How long should a child be on sertraline? A guide to pediatric treatment duration

October 10, 2025 •

4 min read

According to guidelines from the American Academy of Child and Adolescent Psychiatry (AACAP), children and adolescents who respond to antidepressant treatment should continue their medication for 6 to 12 months after their symptoms have resolved. This critical maintenance period helps prevent a relapse, but the question of exactly how long should a child be on sertraline ultimately depends on the individual's specific condition and clinical course.

Quick Summary

The duration a child takes sertraline depends on the diagnosed condition, symptom response, and relapse history. Treatment typically includes a maintenance phase lasting 6 to 12 months post-symptom remission, with longer courses potentially needed for recurring or severe issues. Medication must be tapered off gradually and only under a doctor's supervision.

Key Points

Diagnosis is Key: The duration a child is on sertraline depends heavily on whether they are being treated for depression, anxiety, or OCD.
Maintenance Period Varies: For depression, a typical maintenance phase is 9-12 months after remission, while for anxiety it may be 6-9 months, and for OCD it can be a year or more.
Tapering is Necessary: Medication should never be stopped abruptly; a gradual dose reduction under a doctor's guidance is essential to avoid withdrawal symptoms.
Recurrence May Lengthen Treatment: A history of multiple depressive episodes or a relapse after initial discontinuation can necessitate a longer treatment course.
Ongoing Monitoring is Critical: Regular check-ups are needed to monitor for side effects, growth changes, and potential worsening of symptoms, especially during the first few months of treatment.
Combination Therapy is Best: Sertraline is often most effective when combined with psychotherapy, like CBT, to help children develop long-term coping strategies.
Decision is Individualized: The optimal treatment plan and duration are unique to each child and require close collaboration with a healthcare team.

Sertraline, an SSRI (selective serotonin reuptake inhibitor), is a widely used medication for treating depression and anxiety disorders in children and adolescents. Determining the correct duration of treatment is a crucial decision made in close partnership with a qualified healthcare professional, balancing the need to manage symptoms and prevent recurrence with minimizing medication exposure.

The Phase-Based Approach to Treatment

Sertraline treatment in children and teens is generally divided into three phases, each with a distinct purpose:

Initiation Phase: This initial period involves starting the medication at a low dose and gradually increasing it until an effective and tolerable dosage is found. Side effects are common during this phase but often transient.
Maintenance Phase: Once symptoms have significantly improved or gone into remission, this phase begins. Its primary purpose is to prevent a relapse of the condition. The duration varies depending on the specific diagnosis.
Discontinuation Phase: When it is time to stop the medication, a doctor will oversee a slow, gradual reduction in dosage. Abruptly stopping sertraline is not recommended due to potential withdrawal effects.

Duration for Depression and Anxiety

For most children and adolescents with Major Depressive Disorder (MDD), a maintenance treatment period of 9 to 12 months following symptom remission is recommended. This duration allows the brain time to stabilize after a depressive episode. For anxiety disorders, a slightly shorter maintenance period may be sufficient, but many clinicians extend it to a full year.

Factors Influencing Treatment Length for Depression

Several factors can influence whether a child with depression needs a longer course of treatment:

Severity of the Initial Episode: More severe episodes may warrant a longer maintenance period.
History of Recurrence: Children who have experienced previous depressive episodes may require more extended treatment to reduce the risk of further relapse.
Comorbid Conditions: The presence of other mental health disorders can also affect the treatment timeline.

Duration for Obsessive-Compulsive Disorder (OCD)

Sertraline is also an effective treatment for pediatric OCD. Studies have shown that continued sertraline treatment for up to 52 weeks can be effective and well-tolerated in children and adolescents with OCD, with some patients continuing to improve beyond the initial acute treatment phase. Therefore, the duration for OCD can often be longer than for depression or anxiety, with the decision to taper guided by sustained symptom control.

The Tapering Process: A Critical Step

When a child has achieved full remission and a decision is made to stop the medication, a gradual tapering process is essential. This minimizes the risk of withdrawal-like symptoms, sometimes called antidepressant discontinuation syndrome. A typical tapering schedule involves slowly reducing the dose over several weeks to months, depending on the child’s sensitivity and the length of time they have been on the medication. A hyperbolic tapering method, which involves smaller dose reductions at lower doses, may also be used in youth.

Comparison of Pediatric Sertraline Treatment Durations


Condition	Typical Maintenance Duration (Post-Remission)	Factors Influencing Longer Treatment	Notes
Major Depressive Disorder (MDD)	9-12 months	Multiple past episodes, severe or chronic episodes	Goal is full remission, not just symptom reduction.
Anxiety Disorders (e.g., GAD, Separation Anxiety)	6-9 months (often extended to 12)	Based on clinical judgment and adult extrapolation	Discontinuation often recommended during low-stress periods.
Obsessive-Compulsive Disorder (OCD)	At least 52 weeks or longer	Severity of symptoms, response to initial treatment	Treatment has shown sustained and enhanced effectiveness with continuation.

Long-Term Effects and Monitoring

For most children, the effects of sertraline are well-tolerated, but long-term use requires ongoing monitoring by a healthcare provider. This involves regular check-ins to track physical health, mental status, and developmental milestones. Potential areas of focus include:

Growth and Weight: Regular monitoring of height, weight, and Body Mass Index (BMI) is recommended. While some weight and BMI changes have been noted, they are often minor and may resolve over time.
Suicidal Ideation: A boxed warning highlights an increased risk of suicidal thoughts and behaviors in children and young adults during initial treatment. Close monitoring for mood changes is essential throughout treatment.
Other Side Effects: Ongoing vigilance for potential adverse effects such as agitation, sleep changes, and mood shifts is crucial, and should be reported to the clinician immediately.

The Individualized Nature of Treatment

Ultimately, there is no single answer to how long a child should be on sertraline. The duration is a deeply personalized decision, based on the child's response to medication, the nature of their condition, and other individual circumstances. It is a process that relies heavily on open communication between the child, their parents, and their healthcare team. For many children, sertraline is a bridge to better mental health, allowing them to participate more effectively in therapy and develop coping skills. The ultimate goal is to achieve remission and stability, with medication duration being a tool to reach that goal rather than a permanent state.

For more information on pediatric antidepressant use, consult the resources of authoritative bodies like the Canadian Paediatric Society(https://caringforkids.cps.ca/handouts/mentalhealth/using_ssris_to_treat_depression_and_anxiety_in_children_and_youth).

Conclusion

The question of how long a child should be on sertraline is best answered by careful consideration of their diagnosis, treatment response, and individual risk factors. While maintenance periods of 6 to 12 months are common for depression and anxiety, longer courses are not uncommon, especially for conditions like OCD or in cases of relapse. The decision to stop treatment should always involve a gradual tapering schedule, overseen by a doctor, to prevent withdrawal effects. Ongoing medical and psychiatric supervision is vital to ensure the child’s continued well-being during and after medication use.

Frequently Asked Questions

No, a child should not stop taking sertraline as soon as they feel better. Stopping the medication too soon significantly increases the risk of relapse. For most conditions, a maintenance period of several months is needed after symptoms have resolved to help ensure stability.

Stopping sertraline abruptly can cause withdrawal-like symptoms, also known as discontinuation syndrome. These can include dizziness, nausea, headaches, and a return of the original symptoms. It's crucial to follow a doctor-supervised tapering schedule.

For some children with recurrent or chronic mental health conditions, long-term or indefinite sertraline treatment might be the most appropriate course of action, especially if multiple relapses occur after previous tapers. This decision is made by a healthcare provider on a case-by-case basis.

For Major Depressive Disorder (MDD), the typical maintenance period is 9 to 12 months after symptoms have fully resolved. This period is crucial for preventing a relapse.

Monitoring should be more frequent during the first few months of treatment, often weekly, and then can transition to bi-weekly or monthly as the child stabilizes. Regular check-ins are essential throughout the entire course of treatment.

Some studies have noted minor, and often temporary, changes in weight and BMI with long-term sertraline use. However, no significant dose-related effects on height, cognition, or emotion have been found over a multi-year period. Regular monitoring of growth is recommended.

Yes, if a child's symptoms return after discontinuing the medication, they can often restart sertraline. A doctor will work with the family to re-initiate treatment and adjust the plan as necessary.

No, taking sertraline does not mean a child will be on medication forever. For many, it is a temporary tool to manage symptoms while they learn coping mechanisms through therapy. The goal is to achieve remission, not permanent medication use, though some may require longer treatment.