Mixed data and potentially more side effects than SSRIs (particularly increases in blood pressure and pulse) relegate duloxetine to a second-line option for pediatric depression.

There are no clear advantages to using desvenlafaxine over other agents, particularly venlafaxine XR. Given minimal data in children, venlafaxine is generally preferred when choosing an SNRI.

Citalopram does not have any pediatric indications, and its efficacy data are limited and modest; however, it is a reasonable second-line off-label SSRI option.

Not a first-line antidepressant in kids, but may be useful when depression includes fatigue and poor concentration.

Not as good a choice as we used to think for minimizing risk of weight gain and metabolic side effects, and beware of akathisia.

Bipolar disorder treatment algorithm for children and adolescents

Ramelteon is a melatonin receptor agonist with no data in pediatric patients. 

May be effective and safe for use in performance anxiety, particularly when the sedating or cognitive side effects of benzos could interfere with an individual’s performance, but there are no data in kids.

Although there are only minimal data, consider prazosin for PTSD in kids, especially for PTSD-associated sleep disturbances and nightmares, but monitor BP.

Benzodiazepines are generally only appropriate for use before procedures. Lorazepam probably has less risk of misuse than others. Lorazepam is also the first-line, but off-label, treatment for catatonia.