Antidepressant Medications for Child, Youth
Medication | Forms | Dose (Start, Initial Target, Max) | Comments Indication / Comments | |||
Specific serotonin reuptake inhibitors (SSRI) | ||||||
Fluoxetine* (Prozac) | Tabs: 10,20, 40 Liquid | 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) | Tabs: 10,20,40 mg | 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) | Tabs: 5,10,20 mg | 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) | Tabs: 25,50,100 mg | 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) | Tabs: 50,100 mg | Child: Start 25 mg, initial target 100 mg, max 200 mg daily Adol/adult: Start 50 mg, initial target 100-150 mg, max 300 mg | FDA: OCD (age 8-17) | |||
Paroxetine (Paxil) | Tabs: 10,20,30,40 mg | 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) | Caps 37.5, 75, 150 mg | 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) | Tab: 50,100 mg | 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) | Caps: 20, 30, 60 mg | 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) | Tab: 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) | Tab: 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) | Tab: 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) | Tabs: 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+ |
* Disclaimer: This medication table is a rough summary only and is not a replacement for clinical judgment and consulting a drug reference such as PDR or Lexi-Comps.
References:
- Guidelines for Adolescent Depression in Primary Care (GLAD-PC), 2018
http://www.glad-pc.org/ - Atkinson S et al.: Journal of Child and Adolescent Psychopharmacology. Feb 2018.55-65.http://doi.org/10.1089/cap.2017.0099