Лікарські препарати для тривалого лікування депресії, тривожності та пов'язаних із ними розладів*
Medication | Uses | Starting Dose* | Dose Range* | Comments/Precautions† |
|---|---|---|---|---|
Citalopram | OCD children ≥ 7 years | 10 mg | 10–40 mg/day | — |
Duloxetine | GAD in children 7–17 years | 30 mg | 30–120 mg/ day | — |
Escitalopram | Major depression in children ≥ 12 years | 10 mg | 10–20 mg/day | — |
Fluoxetine‡ | OCD, GAD, separation anxiety, social anxiety, major depression in children > 8 years | 10 mg | 10–60 mg/day | Long-half life |
Fluvoxamine | GAD, separation anxiety, social anxiety, OCD in children > 8 years | 25 mg | 50–200 mg/day | For doses > 50 mg/day, divided into 2 doses/day, with the larger dose given at bedtime |
Paroxetine‡ | OCD in children > 6 years | 10 mg | 10–60 mg/day | Increased weight |
Sertraline | OCD, GAD, separation anxiety, social anxiety in children ≥ 6 years | 25 mg | 25–200 mg/day | — |
Venlafaxine, immediate-release | Depression in children ≥ 8 years | 12.5 mg | 12.5 mg twice a day to 25 mg three times a day | Limited data about dose and concerns about increased suicidal behavior; not as effective as other drugs, possibly because low doses have been used |
Venlafaxine, extended-release | GAD in children > 7 years | 37.5 mg | 37.5–225 mg once a day | |
* Unless otherwise stated, dose is given once a day. Starting dose is increased only if needed. Dose ranges are approximate. Interindividual variability in therapeutic response and adverse effects is considerable. This table is not a substitute for the full prescribing information. | ||||
† Behavioral adverse effects (eg, disinhibition, agitation) are common but are usually mild to moderate. Usually, decreasing the medication dose or changing to a different medication eliminates or reduces these effects. Rarely, such effects are severe (eg, aggressiveness, increased suicidality). Behavioral adverse effects are idiosyncratic and may occur with any antidepressant and at any time during treatment. As a result, children and adolescents taking such medications must be closely monitored. | ||||
‡ Fluoxetine and paroxetine are potent inhibitors of the liver enzymes that metabolize many other drugs (eg, beta-blockers, clonidine, lidocaine). Genetic testing for these metabolic enzymes is available. However, the clinical usefulness remains limited (especially in youths). Clinicians who order these tests need to help families interpret the results (CPIC—Clinical Pharmacogenetics Implementation Consortium). | ||||
GAD = generalized anxiety disorder; OCD = obsessive compulsive disorder. | ||||