Antidepressants of Choice in Adolescents

Q: Which of the following antidepressant is first line for moderate or severe depression treatment in adolescents?










A Cochrane systematic review was done to answer this question: this review included 19 randomized controlled trials including total of3335 patients.


Medications included: fluoxetine, sertraline, escitalopram, citalopram, paroxetine, venlafaxine, and mirtazapine.


Symptom severity score used: Children’s Depression Rating Scale- Revised [CDRS-R].



SSRIs that slightly lowered one symptom severity score on CDRS-R:


  1. Fluoxetine

  2. Sertraline

  3. Escitalopram


  • These three medications did not significantly increased suicide related outcomes.

  • Among other medications: only venlafaxine increased suicide related outcomes.



According to updated NICE guidances (2) following recommendations are provided for moderate to severe depression management in adolescents:


  • First line: fluoxetine.

  • Second line: citalorpam or sertaline.



  1. J Fam Pract. 2016 September;65(9):632-634.
  2. BMJ. 2015;350:h824.

Please do post your questions or comments below. 

Dr. Harvinder Singh, M.D. (Admin)

Enroll in our online course to have access to all important clinically relevant psychiatry topics in one place.

Related Articles