Medication

Forms

Dose (Start, Initial Target, Max)

Comments

Indication / Comments

Specific serotonin reuptake inhibitors (SSRI)

Fluoxetine* (Prozac)

Capsule: 10,20, 40

Liquid (20 mg/5 mL) 

Child: Start 10 mg, initial target 20 mg, max 30-40 mg

Adol: Start 10 mg, initial target 20 mg, max 60 mg

Adult: Start 10 mg, initial target 20, max 60 mg

FDA: MDD, OCD, Bulimia Nervosa, Panic, PMDD MDD (8-17 y/o), OCD (7-17 y/o)

Long half life helpful for those who might miss doses.

Citalopram (Celexa)

Tablet: 10,20,40 mg

Can be cut, crushed (score line) or compounded (4 mg/mL solution). 

Child: Start 5-10 mg, initial target 20 mg, max 40 mg

Adol/adult: Start 20 mg, initial target 20-40 mg, max 40 mg

FDA: MDD (adolescent) ;

Do not exceed 40 mg daily due to QT prolongation

Escitalopram (Cipralex, Lexapro in US)

Tablet: 5,10,20 mg

Can be cut, crushed (score line) or compounded to 2 mg/mL or 8 mg/mL.

Child: Start 5 mg, initial target 10 mg, max 10 mg

Adol/adult: Start 5 mg daily, initial target 10 mg, max 20 mg daily

FDA: MDD & GAD (adolescent)

Do not exceed 20 mg daily due to QT prolongation

Sertraline (Zoloft)

Capsule: 25,50,100 mg

Can be cut, crushed or compounded as 10-20 mg/mL.

Child: Start 25 mg, initial target 50-100 mg, max 150 mg

Adol/adult: Start 25 mg, initial target 100; max 200 mg

FDA: MDD, OCD, Panic, PTSD, PMDD, SAD (adolescent) OCD (age 6-17)

Fluvoxamine (Luvox)

Tablet: 50,100 mg

Can be cut, crushed or compounded (50 mg/5 mL).

Child: Start 25 mg, initial target 50 mg daily, max 100-150 mg daily

Adol/adult: Start 50 mg, initial target 100-150 mg, max 300 mg

FDA: OCD (age 8-17)

Paroxetine (Paxil)

Tablet: 10,20,30,40 mg

Do not crush, break, or chew ER or IR film-coated tablets. 

May be compounded (10 mg/5 mL of IR formulation).

Child: Start 5 mg, initial target 20-30 mg, max 40-60 mg

Adol/adult: Start 10 mg, initial target 20 mg, max 60-100 mg

FDA: MDD, OCD, Panic, SAD, GAD, PTSD -- not 1st line since short half-life and high association with suicidal ideation

Serotonin-noradrenaline reuptake inhibitors (SNRI)

Venlafaxine XR (Effexor)

Capsule: 37.5, 75, 150 mg

Capsule may be opened, and contents sprinkled in food.

Can be compounded.

Child: Start 37.5 mg, initial target 75-112.5 mg, max 150 mg

Age 12+: Start 75 mg, titrate to 75-225 mg daily, max 375 mg

FDA: MDD, GAD, Panic, SAD

3rd line for major depression in children/adolescents (Dopheide, 2006)

Desvenlafaxine (Pristiq)

Tablet (Extended release): 50,100 mg

Tablet cannot be divided, crushed, chewed or dissolved.

Some pharmacies may compound but this changes its release.

Child: Lack of data

Age 12+: Start 50 mg, initial target 50 mg, max 100 mg

Off-label for children; Negative trial for child depression (Atkinson, 2018)

Duloxetine (Cymbalta)

Capsule: 20, 30, 60 mg

Label states capsule should not be opened, but Institute of Safe Medication Practices states capsule can be opened and contents added to apple sauce or apple juice.

Child: Start 30 mg, initial target 60 mg, max 60 mg

Age 12+: Start 30 mg, initial target 60, max 120 mg

FDA: GAD (aged 7+)

Other indications MDD, diabetic neuropathy

Norepinephrine–dopamine reuptake inhibitors (NDRIs)

Bupropion SR

(Wellbutrin SR)

Tablet: 100, 150 mg ;

Do not crush/ cut/ chew

Child: Unknown

Adol/adult: Start 100 mg, initial target 150 mg daily; max 400 mg daily

Depression; ADHD, smoking cessation.

Bupropion XL (Wellbutrin XL)

Tablet: 150, 300 mg ;

do not crush/cut/chew

Child: Unknown

Adol/adult: Start 150 mg, initial target 300 mg; max 450 mg

Depression; ADHD, smoking cessation.

NaSSA (Noradrenergic and specific serotonergic antidepressants)

Mirtazapine (Remeron)

Tablet: 15,30,45 mg

RD: 15,30,45 mg

Child: Unknown

Adol/adult: Start 15 mg qhs, initial target 30 mg qhs, max 45 mg qhs

Off-label in children/youth.

Possibly helpful for comorbid anxiety/depression with ADHD; sleep issues.

Tricyclic Antidepressants (TCAs)

Clomipramine (Anafranil)

Tablet: 10,25,50 mg

Child: Start 25 mg qhs, initial target 100 mg qhs, max 200 mg qhs

Adol/adult: Start 50 mg qhs, initial target 100-200 mg qhs, max 300 mg qhs

FDA approval for OCD, age 10+