Second- or third-line agent due to lack of data. Weight gain and sedation may limit its use in many kids. It may be useful in depressed patients with anxiety or insomnia, those who have had sexual side effects with other antidepressants, and those who may benefit from appetite stimulation. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

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. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Not commonly used in children, but may be considered in those with severe behavioral disturbances who may benefit from sedation. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

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. Dosing at bedtime, or switching to XR, may help reduce daytime sedation. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Adderall is effective but is probably the most misused and diverted of all stimulants, and it tends to have more side effects, all of which is why we recommend starting most patients on methylphenidate instead. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Ramelteon is a melatonin receptor agonist with no data in pediatric patients. In adults, and compared to other hypnotics, ramelteon poses a lower risk for respiratory depression and hangover effect (morning grogginess) but takes longer to take effect. Also consider that over-the-counter melatonin (which ramelteon mimics) may do the same job, possibly at a lower price. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Vyvanse may have a gentler, “smoother” side effect profile than other amphetamines, and probably has a lower risk of diversion or misuse. However, its high cost means insurance companies don’t like to pay for it without prior authorizations. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Due to the lack of large randomized controlled data to support its use and the potential for side effects, clonazepam should be avoided. If you decide to use it, keep it very short term and deploy it adjunctively in kids who exhibit only partial response to first-line therapies (SSRI, SNRI) or have severe anxiety. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Daytrana is helpful for kids who, for whatever reason, cannot use any of the wide variety of oral stimulant preparations. Otherwise, we don’t recommend it due to high cost, lag time for onset of effect, and the side effect of rash, which is pretty common and unpleasant. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Fewer data than SSRIs places venlafaxine in the second-line category for both depression and GAD in kids. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).