4. Antidepressants

BrandGeneric FormStrengthDosingMax doseDurationPeak effect Side effects Notes Tier Sooner CareTier BCBSTier TirCare
* Younger adolescents should be started on lower doses ** Not to be used with MAOI’s
Please go to the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) Tool Kit, pp. 86-90, for complete evidence-based pharmacotherapy.

Used and modified with permission of the REACH Institute, www.TheReachInstitute.org
Adolescent Depression in Primary Care (GLAD-PC) Tool Kit
SSRI1st line ProzacFluoxetineTab

Solution
10, 20, 40

20mg/5ml
10 mg/d, increment of 10-20 mg after weeks60 mg 24-72hrs4-6 wksNausea, dry mouth, HA, somnolence, insomia, tremor, ejaculatory dysfunction, dyspepsia, anxiety



Serisous: serotonin syndrome, increased suicidality/worsening depression, mania
FDA approved
Med Guide
1generic 1Formulary
Second lineZoloftSertralineTab


Solution
25, 50, 100 mg

20 mg/ml
200 mg 24 hrs4-6 wks4-6 wksFDA approved for OCD youth
Med Guide
1generic 1Formulary
Celexa CitalopramTab

Solution
10,20,40

2mg/ml
10 mg/d, increments of 10 mg wkly60 mg24 hrs4-6 wksMed Guide1generic 1Formulary
Lexapro EscitalopramTab

Solution
5,10,20

5mg/5ml
5mg /day, increments of 5 mg 20 mg24 hrs2-6 wksNo RCT evidence for efficacy
Med Guide
1generic 1Formulary
PaxilParoxetineTab/liquid10, 20, 30, 40 mg10 mg daily, increments of 10 mg 60 mg24 hrs4-6 weeksNo RCT evidence for efficacy
Med guide
1generic 1Formulary
LuvoxFluvoxetine Tab/liquid20, 50, 100 mg 25-50 mg daily then BID, increments of 25-50 mg300 mg24 hrs4-6 weeksNo RCT evidence for efficacy. Luvox discontinued in US
Med guide
1generic 1Formulary