antidepressants

Danger

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Medication	Indication	Dose Range	How to Start	Dosing Instructions	How to Take	Side Effects	Interactions	Key Notes
Fluoxetine	MDD (8+), OCD (7+), anxiety, bulimia (off-label)	10–80 mg/day (avg ~25 mg for OCD)	10 mg/day	Once daily; long half-life allows flexible scheduling	Oral capsule or liquid; with or without food	GI upset, insomnia, headache, activation, rare sexual side effects in youth	CYP2D6, 2C19 inhibitor; avoid QTc-prolonging drugs	Best evidence in pediatric MDD; low withdrawal risk; good for poor adherence
Sertraline	OCD (6+), MDD, anxiety disorders	50–200 mg/day (avg ~178 mg OCD)	25–50 mg/day (12.5 mg in young children)	May split dose if <200 mg/day due to short half-life	Oral tablet or liquid; with or without food	GI distress, insomnia, QTc prolongation (rare)	CYP 2B6, 2C19, 2D6 interactions	First-line for pediatric anxiety and OCD; strong evidence from CAMS and POTS
Escitalopram	MDD (12+), GAD (adults)	10–20 mg/day	10 mg/day	Once daily; adjust for renal/hepatic impairment	Oral tablet or solution	GI symptoms, headache, possible QT prolongation	CYP2D6, 3A4, 2C19	Effective in teens; lacks pediatric anxiety-specific RCTs
Citalopram	MDD (off-label in youth)	10–40 mg/day	10 mg/day	Do not exceed 40 mg/day due to QT risk	Oral tablet or solution	QT prolongation, sedation, GI upset	Weak inhibition of 3A4, 2C19, 2D6	Avoid in cardiac risk; inconsistent pediatric efficacy
Fluvoxamine	OCD (8+), social anxiety (off-label)	50–300 mg/day (avg ~165 mg OCD)	25–50 mg/day	Adjust by age; titrate slowly	Oral tablet	Sleep disturbance, nausea, low sexual side effect profile	Inhibits CYP 1A2, 2C19, 3A4	Effective for OCD; not shown effective for depression