Paediatric psychopharmacology — structured clinical viva

Indication. Moderate adolescent MDD with incomplete CBT response and NSSI supports considering fluoxetine plus ongoing psychological and family work, after bipolar screen, substance review, and risk formulation. TADS supports fluoxetine/combination acute signals.[2][5]

Consent. Assess Gillick/developmental competence; engage parents; private youth interview with explained confidentiality limits. Black-box: small absolute suicidality signal in paediatric antidepressant trials → early monitoring and means restriction, not fear-based undertreatment alone.[1][5][6]

Regimen. Example: fluoxetine 10 mg orally daily → 20 mg daily; early reviews; safety plan. If psychotic depression emerges later, escalate intensity, specialist review, and if an SGA is used apply Correll-style metabolic monitoring from baseline at lowest effective dose — not casual olanzapine convenience dosing.[2][3][5]

Brother ADHD contrast. Stimulant-first after multi-setting diagnosis; growth, BP/HR, appetite/sleep, diversion counselling; serious CV events uncommon but history/symptom vigilance (Cooper). Different adverse-effect script from SSRI black-box conversation.[4]