For pediatric patients who are being successfully treated for migraines with a TCA such as amitriptyline, would you consider starting an additional SSRI or SNRI for mood/anxiety symptoms, given the risk of serotonin syndrome?

Alternatively, would you titrate the TCA up to therapeutic dosage for treatment of psychiatric symptoms?

Answer from: at Community Practice

My first inclination would be to just increase the TCA that is already being used and bring it up to therapeutic levels for antidepressant and anxiolitic effects. The TCAs are very effective antidepressants but come with a wider array of side effects which makes compliance a bigger issue with these ...

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For pediatric patients who are being successfully treated for migraines with a TCA such as amitriptyline, would you consider starting an additional SSRI or SNRI for mood/anxiety symptoms, given the risk of serotonin syndrome?

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