Antidepressant doses for pediatric unipolar major depression

Antidepressant class	Medication	Starting dose (mg/day)	Typical dose range (mg/day)
Selective serotonin reuptake inhibitors	Citalopram	10	20 to 40^*
	Escitalopram	5	10 to 20
	Fluoxetine	5 to 10	20 to 60
	Fluvoxamine	25	50 to 200 in two divided doses
	Paroxetine^¶	10	20 to 60
	Sertraline	25	50 to 200
Serotonin-norepinephrine reuptake inhibitors	Desvenlafaxine	25	25 to 100
	Duloxetine	20 to 30	40 to 60
	Venlafaxine XR	37.5	150 to 225
Serotonin modulators	Vilazodone	10	10 to 40
Serotonin modulators	Vortioxetine	5	5 to 20
Atypical agents	Bupropion IR	37.5 to 100 mg two divided doses	100 to 300 in two divided doses
	Bupropion SR	2 mg/kg (maximum 100 mg)	3 to 6 mg/kg (maximum 200 to 300 mg) in two divided doses
	Bupropion XL	150	300 to 450
	Mirtazapine	7.5	15 to 45

This table is for use in conjunction with UpToDate content on pharmacotherapy of pediatric unipolar depression. Not all agents listed have demonstrated benefit for treatment of depression in children in clinical trials and use of antidepressants in children is off label for most agents except fluoxetine and escitalopram. In general, low doses within range have been used in prepubertal children (eg, age ≥7 to 12 years); whereas moderate and higher end doses in range have been used in adolescents. Refer to UpToDate for considerations in choosing pharmacotherapy and determining initial and titration dosing for medication trial.

The doses of some of these medications require adjustment or avoidance in liver or kidney insufficiency, other comorbidity, or for interacting medications. Refer to the Lexicomp drug-specific monographs for dose adjustments.

IR: immediate release; SR: sustained release (12 hour); XL, XR: extended release (24 hour).

* A maximum citalopram dose of 60 mg/day has been used in some adolescents; refer to topic for cardiac precautions.

¶ Paroxetine is no longer recommended for pediatric unipolar depression.

References:

Bloch MH, Beyer C, Martin A, Scahill L. Antidepressants. In: Lewis's Child and Adolescent Psychiatry: A Comprehensive Textbook, Fifth Edition, Martin A, Bloch MH, Volkmar FR (Eds), Wolters Kluwer, Philadelphia 2018. p.724.
Emslie GJ, Stone LA, Jones JM. Antidepressants. In: Dulcan's Textbook of Child and Adolescent Psychiatry, Third Edition, Dulcan MK (Ed), American Psychiatric Association Publishing, Washington, DC 2022. p.729.
Kim G-M, Gandhi R, Cullen KR. Pharmacotherapy for pediatric depression. In: Clinical Handbook for the Diagnosis and Treatment of Pediatric Mood Disorders, Singh MK (Ed), American Psychiatric Association Publishing, Washington, DC 2019. p.241.
Birmaher B, Rengasamy M. Major depressive disorder. In: Clinical Manual of Child and Adolescent Psychopharmacology, Fourth Edition, McVoy M, Stepanova E, Findling RL (Eds), American Psychiatric Association Publishing, Washington, DC 2024. p.199.

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Antidepressant doses for pediatric unipolar major depression