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Drugs for Long-Term Treatment of Depression, Anxiety, and Related Disorders

Drugs for Long-Term Treatment of Depression, Anxiety, and Related Disorders

Drug

Uses

Starting Dose*

Dose Range*

Comments/Precautions†

Citalopram

OCD

children 7 years

10 mg

10–40 mg/day

Duloxetine

GAD in children 7–17 years

30 mg

30–120 mg/ day

Escitalopram

Major depression in children 12 years

10 mg

10–20 mg/day

Fluoxetine

OCD, GAD, separation anxiety, social anxiety, major depression in children > 8 years

10 mg

10–60 mg/day

Long-half life

Fluvoxamine

GAD, separation anxiety, social anxiety, OCD in children > 8 years

25 mg

50–200 mg/day

For doses > 50 mg/day, divided into 2 doses/day, with the larger dose given at bedtime

Paroxetine

OCD in children > 6 years

10 mg

10–60 mg/day

Increased weight

Sertraline

OCD, GAD, separation anxiety, social anxiety in children 6 years

25 mg

25–200 mg/day

Venlafaxine, immediate-release

Depression in children 8 years

12.5 mg

12.5 mg twice a day to 25 mg three times a day

Limited data about dose and concerns about increased suicidal behavior; not as effective as other drugs, possibly because low doses have been used

Venlafaxine, extended-release

GAD in children > 7 years

37.5 mg

37.5–225 mg once a day

* Unless otherwise stated, dose is given once a day. Starting dose is increased only if needed. Dose ranges are approximate. Interindividual variability in therapeutic response and adverse effects is considerable. This table is not a substitute for the full prescribing information.

† Behavioral adverse effects (eg, disinhibition, agitation) are common but are usually mild to moderate. Usually, decreasing the drug dose or changing to a different drug eliminates or reduces these effects. Rarely, such effects are severe (eg, aggressiveness, increased suicidality). Behavioral adverse effects are idiosyncratic and may occur with any antidepressant and at any time during treatment. As a result, children and adolescents taking such drugs must be closely monitored.

Fluoxetine and paroxetine are potent inhibitors of the liver enzymes that metabolize many other drugs (eg, beta-blockers, clonidine, lidocaine). Genetic testing for these metabolic enzymes is available. However, the clinical usefulness remains limited (especially in youths). Clinicians who order these tests need to help families interpret the results ( CPIC—Clinical Pharmacogenetics Implementation Consortium).

GAD = generalized anxiety disorder; OCD = obsessive compulsive disorder.