Psychopharmacology for Pediatric Depressive Disorders

Major depressive disorder (MDD) contributes to significant morbidity and mortality in youth. Psychopharmacological antidepressant treatment plays an important role in treatment of pediatric MDD, in conjunction with psychotherapy/psychosocial treatments. In this chapter, we review antidepressant medications, their research evidence, and implications for clinical care. Common antidepressant treatments for youth include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). For youth with partial response to treatments, common augmenting agents, such as second-generation antipsychotics (SGAs) and bupropion, are discussed. For all relevant medications, we describe background information, evidence of efficacy, medication safety concerns, and practical prescribing information. In addition, we cover several special topics, including a review of the FDA boxed warning for suicidality, implications of psychopharmacological study design, and evidence for continuation/maintenance treatment. Lastly, figures and tables provide suggested treatment algorithms, dosing regimens, cross-tapering strategies, and clinical pearls related to dosing and decision-making. This comprehensive chapter provides a valuable resource for the psychopharmacological treatment of pediatric depression for prescribers across multiple disciplines and levels of expertise.