What is the first-line antidepressant for children?

• A. Prozac
• B. Zoloft
• C. Paxil
• D. Celexa

Answer: (A)

Fluoxetine is the best first-line antidepressant for children because it has the strongest pediatric evidence and the only FDA approval for major depressive disorder in children and adolescents among the options. This approval and data base mean there’s reliable guidance on dosing, efficacy, and safety in youth. Other choices either lack pediatric MDD approval or carry safety concerns in young patients (for example, paroxetine has documented suicidality risks in youths; citalopram lacks pediatric MDD approval and can affect QT interval; sertraline is approved for pediatric OCD and some anxiety disorders but not primary pediatric depression). Starting with fluoxetine and monitoring closely for activation and suicidality, often in conjunction with psychotherapy, aligns with current pediatric treatment practice.