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Medications that can help with anxiety and depression target different chemicals in the body:
Serotonin is the body’s “feel good” chemical.
Norepinephrine is the body’s “fight or flight” chemical and increase alertness and energy.
Dopamine is the body’s “pleasure” chemical.
While selective serotonin reuptake inhibitors (SSRIs) remain first line medications for childhood and adolescent anxiety and depression, medications that target other chemicals are also available for use. They may be recommended if your child does not respond adequately to or tolerate SSRIs or can be used together with a SSRI for enhanced effects.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Similar to SSRIs, SNRIs work by preventing the brain from reabsorbing serotonin but also norepinephrine. Both are neurotransmitters within the brain that can help regulate mood and anxiety levels so allowing them to remain active for a longer period of time can help improve mood and lessen anxiety. They can also help improve attention, memory, energy, and chronic pain.
Venlafaxine (Effexor), Duloxetine (Cymbalta)
FDA Approved for 18+ yo only: Desvenlafaxine (Pristiq), Milnacipran (Savella), Levomilnacipran (Fetzima)
Common side effects may include:
Abdominal pain
Dizziness
Dry mouth
Excessive sweating
Headache
Insomnia
Constipation
High blood pressure
Sexual dysfunction
Weight gain
Rare side effects may include :
QT prolongation – an abnormality of the heart’s rhythm that can be life-threatening if untreated
Suicidal thoughts – more common in younger patients
Withdrawal symptoms – can occur if the medication is stopped abruptly leading to dizziness, nausea/vomiting, excessive sweating, sleep disturbance, or increased anxiety
Serotonin syndrome – when too much serotonin build up in the body leading to shivering, increased heart rate, blood pressure, and temperature, diarrhea, anxiety, confusion, stiff muscles, seizures, and irregular heart beats. In rare cases, it can be life threatening and requires emergent care.
Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs)
Similar to SSRIs and SNRIs, NDRIs work by preventing the brain from reabsorbing neurotransmitters (norepinephrine and dopamine in this case) that can help improve mood, motivation, and focus. While used primarily to treat depression and seasonal affective disorder, NDRIs are also used for ADHD and smoking cessation. Because they do not target serotonin, they cause fewer sexual side effects and are less likely to lead to weight gain.
Bupropion (Wellbutrin), Methylphenidate (Ritalin, Concerta), Dexmethylphenidate (Focalin)
Common side effects may include:
Decreased appetite
Dry mouth
Insomnia
Nausea
Headache
Tremors
Poor appetite
Constipation
Weight loss
Rare side effects may include:
Risk of seizures in patients with underlying epilepsy, eating disorders with bupropion
Atypical Antipsychotics
This class of medicine works by blocking serotonin and less strongly, dopamine receptors. This leads to better balance of dopamine and serotonin in the brain. While higher levels of both can help improve mood and anxiety, too much of either neurotransmitters can cause undesirable symptoms such as poor impulse control, anxiety, aggression, mania or feelings of being on “overdrive”, delusions, and hallucinations. It is used in cases of treatment-resistant depression, bipolar disorder, schizophrenia, and agitation and aggression sometimes observed in autism spectrum disorder or dementia..
Aripiprazole (Abilify), Risperidone (Risperdal), Quetiapine (Seroquel), Olanzapine (Zyprexa), Clozapine (Clozaril), Ziprasidone (Geodon), Asenapine (Saphris), Iloperidone (Fanapt)
Common side effects may include:
Dry mouth
Constipation
Urinary retention
Blurred vision
Metabolic syndrome including weight gain, high blood sugar, and abnormal cholesterol
Thyroid function abnormalities
Sleepiness – more common with clozapine, quetiapine, and olanzapine
Dizziness especially with sitting up or standing
Rare side effects may include:
Elevated prolactin level leading to breast development even in boys
*Due to their potential effect on the body’s metabolism, baseline and regular lab checks are required when taking these medications.
📚 References
By PL, MD and HB, MD, Behavioral Health Committee. 03/2026.