Childhood and Adolescent (Pediatric) Depression

Childhood and Adolescent Depression is a mental disorder characterized by low mood, anxiety, and irritability in children and youth.

Antidepressants should never be a first-line treatment for child/adolescent depression. Recent studies have shown no benefit of adding fluoxetine to CBT in the treatment of even moderate-severe depression.[1]

Cognitive behavioural therapy is the first line treatment for paediatric depression.

If medications are required, fluoxetine is generally the first medication choice for pediatric depression because there is FDA approval for MDD (as well as OCD) in youth. It has the most evidence to support efficacy for 
pediatric MDD, especially in children <12 years. Fluoxetine also has a long half-life if non-adherence is a 
concern, which minimizes the risk of withdrawal. Unlike the other SSRIs, it is also available as an oral 
solution (liquid).
 Citalopram, escitalopram, or sertraline might be picked over fluoxetine if there are potential drug interactions with fluoxetine, or if there are significant concerns about a long half-life agent because the patient 
has risk factors for bipolar disorder.

Since children have an increased rate of drug metabolism, BID dosing at lower dosages is recommended for all SSRIs except fluoxetine to minimize the risk of daily withdrawal symptoms.