Table 1.
First-line pharmacological treatments for adult depression and evidence of their effects in pediatric populations
| Pediatric |
Adult |
||||||||
|---|---|---|---|---|---|---|---|---|---|
| Starting dose (mg/day) | Typical dose range (mg/day) | Level of evidence in MDD | FDA indications | Starting dose (mg/day) | Typical dose range (mg/day) | Level of evidence in MDD | FDA indications | Half-life | |
| Selective serotonin reuptake inhibitors | |||||||||
| Citalopram | 10–20 | 20–40 | C | – | 20 | 40 | A | MDD | 20 hr |
| Escitalopram | 10 | 10–20 | A | MDD (12+) | 10 | 10–20 | A | MDD, GAD | 27–32 hr |
| Fluoxetine | 10–20 | 20–80 | A | MDD (8+), OCD (7+) | 20 | 20–80 | A | MDD, OCD, PD | 4–6 days |
| Fluvoxamine | 25–50 | 50–300 | C | OCD (8+) | 100–300 | 100–300 | A | OCD | 16 hr |
| Paroxetine | 10–20 | 20–60 | C | – | 10–20 | 40–60 | A | MDD, OCD, PTSD, GAD, SAD, PD | 21 hr |
| Sertraline | 25–50 | 100–200 | A | OCD (6+) | 50 | 150–250 | A | MDD, OCD, PTSD, SAD, PD | 26 hr |
| Serotonin–norepinephrine reuptake inhibitors | |||||||||
| Venlafaxine | 37.5 | 150–225 | C | – | 37.5–75 | 75–375 | A | MDD, GAD, SAD, PD | 10 hr |
| Duloxetine | 30 | 40–60 | C | GAD (7+) | 20–60 | 20–80 | A | MDD, GAD | 12.5 hr |
| Desvenlafaxine | 25 | 25–100 | C | – | 50 | 50–400 | A | MDD | 11 hr |
| Atypical antidepressants | |||||||||
| Bupropion | 100 | 150–300 | C | – | 100–150 | 150–300 | A | MDD | 21 hr |
| Mirtazapine | 7.5–15 | 15–45 | C | – | 15 | 15–45 | A | MDD | 20–40 hr |
| Vilazodone | 5 | 10–20 | C | – | 10 | 10–40 | A | MDD | 25 hr |
| Vortioxetine | 5 | 10–20 | C | – | 10 | 10–80 | A | MDD | 66 hr |
Table 1 depicts pharmacological agents approved for the treatment of adult major depressive disorder (MDD) and their current level of evidence of efficacy in children. Only two medications are FDA-approved for treatment of major depression in pediatric populations (fluoxetine and escitalopram) depicted in bold. Sertraline has additional evidence of efficacy in multiple placebo-controlled trials in pediatric populations. Levels of evidence in both adult and pediatric patients are based on grades developed from the National Guidelines Clearinghouse (AHRQ; Shekelle, Woolf, Eccles, & Grimshaw, 1999). Grade A evidence is based on meta-analysis of randomized controlled trial (RCT) data or 1 or more RCTs. Grade B evidence is based on at least 1 controlled trial that was not randomized. Grade C evidence is based on either data from nonexperimental studies or extrapolated from Grade A or Grade B evidence in a different population. Grade D is based on expert opinion or clinical experience. Medication half-life is based on available data from adult populations. For pediatric approved medications, minimal age of approval in years is depicted in parentheses. GAD, generalized anxiety disorder; MDD, major depressive disorder; mg, milligrams; OCD, obsessive–compulsive disorder; PD, panic disorder; PTSD, post-traumatic stress disorder; SAD, social anxiety disorder.