Along with lithium, valproate is a first-line antimanic agent for acute manic episodes in kids. Avoid in patients with ovaries due to risk of PCOS as well as risk of congenital malformation; if used, ensure adequate contraception (ideally IUD or depot contraceptive). 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).

Brexpiprazole is a cousin of aripiprazole and is also a partial dopamine agonist. It has a very similar efficacy profile (including efficacy for depression in adults) and a similar side effect profile, but is much more expensive and has less data and experience in children. We recommend choosing the cheaper, generic aripiprazole. From the Child Medication Fact Book for Psychiatric Practice, Second Edition (2023).

Consider fluoxetine a first-line agent for kids with depression and anxiety disorders. 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).

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).

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).

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).

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).

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).