Clinical guidelines for adolescent depression: An integrated traditional Chinese and Western medicine approach

Table 3 Selective serotonin reuptake inhibitors titration schedule (mg/day)

Medication	Starting dose	Increments	Effective dose	Maximum dose	Titration period	Safety instructions
Fluoxetine	10	10-20	20	60	Titrate to 20 mg/day after 1 week; consider lower dose for low-weight adolescent	Monitor for suicidal ideation and behavior
						Contraindicated with MAOIs
						Long half-life
						Monitor for activation syndrome
						Refer to prescribing information for complete safety data
Sertraline	25	12.5-25	50	200	Titrate over 2-4 weeks, intervals ≥ 1 week	Monitor for suicidal ideation and behavior
						Contraindicated with MAOIs
						QT prolongation risk; ECG monitoring when indicated
						Monitor for manic switch
						Monitor for abnormal bleeding
						Periodic hepatic and renal function monitoring
						Refer to prescribing information for complete safety data
Escitalopram	10	5	10	20	Titrate over 2-4 weeks, intervals ≥ 1 week	Monitor for suicidal ideation and behavior
						Contraindicated with MAOIs
						Monitor for manic switch
						Monitor for abnormal bleeding
						Monitor for serotonin syndrome
						Monitor for hyponatremia
						Refer to prescribing information for complete safety data
Citalopram	10	10	20	40	Titrate over 2-4 weeks, intervals ≥ 1 week	Monitor for suicidal ideation and behavior
						Contraindicated with MAOIs
						Monitor for manic switch
						Monitor for serotonin syndrome
						Monitor for hyponatremia
						Refer to prescribing information for complete safety data
Fluvoxamine	25	25	50	200	Titrate by 25 mg every 4-7 days	Monitor for suicidal ideation and behavior
						Contraindicated with MAOIs
						Monitor for manic switch
						CYP450 inhibitor; multiple drug interactions
						Refer to prescribing information for complete safety data

MAOIs: Monoamine oxidase inhibitors; QT: QT interval; ECG: Electrocardiogram.