Escitalopram for the treatment of major depressive disorder in youth

INTRODUCTION: Major depressive disorder (MDD) is a serious public problem, affecting 4 - 6% of adolescents at any one time. Although adolescent MDD needs early and appropriate intervention, concerns regarding the risk of suicidality associated with antidepressant treatment and efficacy of pharmacotherapy have led to decreased use of antidepressants in children and adolescents. After the approval of fluoxetine in 2003, escitalopram received FDA approval in 2009 for the acute and maintenance treatment of MDD in adolescent patients. AREAS COVERED: The paper addressed the following questions: Is escitalopram effective for adolescent MDD? How large is the magnitude of effectiveness? Does escitalopram treatment have any benefit in adolescents compared with the risk of suicidal behavior and treatment-emergent adverse events? EXPERT OPINION: The efficacy of escitalopram in adolescent MDD was demonstrated in a double-blind, randomized, controlled trial and extrapolated from a similar citalopram trial. The optimal dose is 10 mg/day and the magnitude of the antidepressant effect is modest. Escitalopram treatment is generally well tolerated by adolescents, but treatment-emergent agitation, suicidal behavior and manic symptoms should be closely monitored. Escitalopram can be used as one of the first-line treatment options for moderate to severe MDD in adolescents.