Table 3. Pharmacologic treatments for children with major depressive disorder.

*First-line treatment

SSRI: selective serotonin reuptake inhibitor; TCAs: tricyclic antidepressants; SNRI: serotonin-norepinephrine reuptake inhibitor

[20,27,30-32]

Medication	Drug class	Formulation	Dosing	Duration	Potential side effects	Special notes
Fluoxetine*	SSRI	Capsule, tablet, or liquid	Starting dose: 10-20 mg/day; typical dose: 20-80 mg/day	Initial treatment: 4-6 weeks; minimum duration for one depressive episode: 1 year	Treatment-induced suicidality, increased BMI, and mania	May be up to three times as potent in pediatrics than in adults. Approved for the treatment of ≥8 years old. Contraindicated with the use of TCAs, antiarrhythmic drugs, and neuroleptics. FDA recommends a four-week follow-up. FDA approved
Escitalopram*	SSRI	Capsule, tablet, or liquid	Starting dose: 5-10 mg/day; typical dose: 10-40 mg/day	Initial treatment: 4-6 weeks; minimum duration for one depressive episode: 1 year	Increased BMI and mania	Approved for the treatment of ≥12 years old. FDA approved
Duloxetine	SNRI	Capsule or tablet	Starting dose: 30 mg/day; typical dose: 40-60 mg/day	Initial treatment: 6-8 weeks	Weight loss, changes in systolic blood pressure, and changes in heart rate	First-line SNRI