Antidepressant Medications for Child, Youth
Medication |
Forms |
Dose (Start, Initial Target, Max) |
Comments Indication / Comments |
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Specific serotonin reuptake inhibitors (SSRI) |
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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. |
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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 |
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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.
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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 |
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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) |
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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) |
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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 |
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Serotonin-noradrenaline reuptake inhibitors (SNRI) |
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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) |
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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) |
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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 |
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Norepinephrine–dopamine reuptake inhibitors (NDRIs) |
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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. |
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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. |
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NaSSA (Noradrenergic and specific serotonergic antidepressants) |
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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. |
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Tricyclic Antidepressants (TCAs) |
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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+ |
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Amitriptyline (Elavil) | Tablet:10,25,50 mg | Adult: Start 50 mg bedtime, increase up to 150 mg max. |
* 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:
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Guidelines for Adolescent Depression in Primary Care (GLAD-PC), 2018
http://www.glad-pc.org/