SSRIs: First Line Medications for Pediatric Anxiety and Depression
Drug FDA
Formulations Dosing Pharm. Props. Side Effects Comments
(Brand) Approval
Fluoxetine MDD ≥ 8yo, Capsules: 10/20/40mg - Start 10mg QD ○ Long half-life (days) SAME FOR ALL SSRIs: • ALL SSRIs: Usually takes
(Prozac) OCD ≥ 7yo (5mg/day for younger) 2-4 weeks to see
Tabs: 10/20/60mg - Initial target 20mg QD ○ Out of system 1 m COMMON: effects; 4-8 weeks to
- Monthly increments/ after stopping Nausea see full effects
Sol: 20mg/5mL decrements 10-20mg Headaches • Good for nonadh. pts
- FDA Max 60mg/day (20- ○ Strong P450 Dry mouth due to long T ½
30mg/day for younger interaction (2D6, Fatigue • Discontinuation
children) 2C19 inhibitor) Diarrhea symptoms less likely
Constipation • More potential for
Sweating drug-drug interactions
Sexual side effects
Activation/anxiety
Sertraline OCD ≥ 6yo Tabs: 25/50/100mg - Start 25mg QD; 12.5 mg ○ Medium half-life • Unlikely to have drug-
(Zoloft) for younger children (1 day) RARE: drug interactions
Sol: 20mg/mL - Initial target ~50mg QD Increase suicidal • May have
- Monthly increments/ ○ Out of system 1 ideation (not completed discontinuation
decrements 25-50 mg week after suicide) symptoms; taper off
- FDA Max 200mg/day stopping Hypo/mania
○ Weak P450
interaction
Escitalopram MDD ≥ 12yo Tabs: - Start 5 mg QD, ○ Medium half-life EXTREMELY RARE: • Unlikely to have drug-
(Lexapro) 5/10/20mg - Initial target ~10mg QD (1 day) Seizures (OD) drug interactions
GAD>7 - Monthly Serotonin syndrome • May have
Sol: increments/decrements 5- ○ Out of system discontinuation
5mg/5mL 10mg 1 week after symptoms; taper off
- FDA Max 20mg/day stopping
○ No P450
interaction
03/24
Questions? Call Project TEACH: Clinical Consultation Line: 1-855-227-7272 (Monday-Friday • 9 am – 5 pm)
New York State’s Child/Adolescent & Perinatal Psychiatry Access Program • [Link]
Other Medications Used for Pediatric Anxiety and Depression
Drug
Class FDA Formulations Dosing Pharm Properties Side effects Comments
(Brand) approval
• Rarely used in children due to
Citalopram SSRI None Tabs: 10/20/40mg - Start 10mg QD, ○ Medium half-life Same as SSRIs QT prolongation
(Celexa) in child/ initial target 20mg QD (>1d)
• PLUS: QT prolongation • Unlikely to have drug-drug
adols. Sol: 10mg/5mL - Monthly in/decrements interactions
○ P450 interaction
10-20mg weak • May have discontinuation
symptoms; taper off
- Max 40mg/day
• Used only for OCD
Fluvoxamine SSRI OCD ≥ 8yo Tabs: 25/50/100mg - Start 25mg QHS, initial ○ Short half-life (15h) Same as SSRIs • BID dosing
(Luvox) target 50mg/day; BID • More likely to have drug-drug
dosing ○ P450 interaction
Strong interactions
- 25-50mg in/decrement • Likely to have discontinuation
symptoms; taper slower
- Max 200mg/day up to
11yo, 300mg/day 11+yo
• IR needs BID dosing and is
Venlafaxine SNRI None Tabs: - Use ER formulations ○ Short half life Same as SSRIs difficult to discontinue; taper
(Effexor) in child/ 25/37.5/50/75/100mg (5 h parent, 11h
active metab) • Increase diastolic BP at very slowly
adols. - Start 37.5mg QD,
initial target 75mg/day higher doses • ER formulations
ER Caps: ○ Weak P450 recommended
37.5/75/150mg - 37.5-75mg interaction • Less likely to have drug-drug
in/decrements interactions
ER Tabs:
37.5/75/150/225mg - FDA Max 225mg/day
- Start 30mg QD, • QD-BID dosing
Duloxetine SNRI GAD ≥ 7yo Caps: 20/30/40/60mg ○ Medium half-life (12 Same as SSRIs • May be more difficult to wean
initial target 30 mg hours)
(Cymbalta) off
- 30mg in/decrements ○ Moderate P450 • Do not open cap
interaction • More likely to have drug-drug
- Usually given as BID interactions
- FDA Max 120mg/day • Analgesic effect in adults
• XL form preferred as QD
Bupropion DNRI None Tabs: 75/100mg (TID) - Start 150mg XL daily, ○ Medium half-life (21 Same as SSRIs • Relative contraindication
(Wellbutrin) in child/ increase after 1-2 weeks hours)
to 300 mg XL PLUS eating disorders, ETOH abuse
adols. ER Tabs (12h):
○ Strong P450 1. Lowers seizure • Used for smoking cessation,
100/150/200/ 300mg - FDA Max 450mg/day interaction threshold 4th line ADHD (12+)
(BID) 2. Lower likelihood of • Not effective for anxiety; may
sexual side effects worsen
XL tabs (24h):
• More likely to have drug-drug
150/300 (QD) interactions
Questions? Call Project TEACH: Clinical Consultation Line: 1-855-227-7272 (Monday-Friday • 9 am – 5 pm)
New York State’s Child/Adolescent & Perinatal Psychiatry Access Program • [Link]
