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?

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 anxiolytic effects. The TCAs are very effective antidepressants but come with a wider array of side effects, which makes compliance a bigger issue with these...

TCAs, except for imipramine and clomipramine, have weak serotonergic properties; thus, the risk of 5HT syndrome is low compared to SSRIs. And generally, the TCA dosages used by neuro are low. Considering the risk associated with TCAs in peds and possibly limited evidence on its benefits in pediatric...