Due to its longer half-life, clonazepam causes fewer breakthrough symptoms compared to alprazolam when used for anxiety. May also work as a good short-term hypnotic, although development of dependence and long half-life limit this use.

Buspirone is a reasonable option in anxious patients for whom benzodiazepines are not appropriate. Don’t expect as robust a response, and make sure patients know it may take a week or two to kick in.

Alprazolam is fast-acting and effective for generalized anxiety disorder (GAD) and panic disorder, but its short duration of action may contribute to breakthrough symptoms between doses and make withdrawal more difficult.

Lower risk for EPS and a broad spectrum of efficacy make this an appealing first-choice agent. However, sedation, weight gain, and orthostasis may limit use. 

Not for first-line use for most kids due to limited data (open-label studies only), long titration required, and increased relative risk of rash in pediatric population.

Dexmethylphenidate (d-MPH, brand name Focalin) is the D-isomer of methylphenidate and is twice as potent as methylphenidate. 

Not commonly used due to side effects and toxicity risk; however, TCAs should be considered for kids who do not respond to other antidepressants.

Not commonly used due to side effects and toxicity risk; however, TCAs should be considered for kids who do not respond to other antidepressants.

Limited evidence to support its use, but fairly commonly used for insomnia in clinical practice.

Consider sertraline a first-line agent for kids with depression and anxiety disorders.