Escitalopram in adolescent major depression

Escitalopram is the purified functional isomer contained in citalopram. Escitalopram is now prescribed in 26 countries. In the United States, the only US Food and Drug Administration (FDA)-approved selective serotonin reuptake inhibiter (SSRI) for adolescents is fluoxetine. However, in clinical practice all antidepressants are used in adolescents. Five patients had parents who opted for the use of escitalopram instead of other treatments. Reasons included poor response and side effects from other SSRIs. Specifically, escitalopram was considered possibly less likely to cause obesity than paroxetine. It also caused a lower frequency of akathisia than fluoxetine, more stable blood levels over years than sertraline, very low drug interactions, and a low onset of anxiety if using a 5-mg starting dose. Although studies in adolescents are very limited for escitalopram, its parent medication--citalopram--has been used in over 40 million patients. Parents and adolescent patients should be made aware of all antidepressant options, if psychopharmacology is indicated. In some patients, escitalopram may have use.