From the Guidelines
Escitalopram is a recommended treatment option for anxiety disorders in children and adolescents, with a standard starting dose of 10mg once daily, due to its efficacy and relatively favorable side effect profile, as supported by the most recent clinical practice guideline 1.
Key Considerations
- The medication should be initiated at a low dose and slowly titrated upwards to minimize the risk of adverse effects, particularly behavioral activation/agitation, which is more common in younger children 1.
- Patients should be closely monitored for suicidal thinking and behavior, especially in the first months of treatment and following dosage adjustments, as all SSRIs have a boxed warning for this risk 1.
- Common side effects of escitalopram include nausea, insomnia, sexual dysfunction, dry mouth, and dizziness, which often improve over time 1.
- Treatment duration varies based on the condition, but patients generally need to take escitalopram for at least 6-12 months after symptom improvement to prevent relapse.
Important Safety Information
- Escitalopram, like other SSRIs, can increase the risk of serotonin syndrome, a potentially life-threatening condition caused by elevated brain serotonin levels, when combined with other serotonergic medications 1.
- The medication should be used cautiously in patients with a history of seizure disorder, as SSRIs can lower the seizure threshold 1.
- Abnormal bleeding, including ecchymosis, hematoma, epistaxis, petechiae, and hemorrhage, can occur with SSRIs, especially when combined with aspirin or nonsteroidal anti-inflammatory drugs 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Overview of Escitalopram
- Escitalopram is the therapeutically active S-enantiomer of RS-citalopram, a commonly prescribed SSRI 2.
- It is a highly selective inhibitor for the serotonin transporter, ameliorating depressive symptoms in patients with MDD at half the RS-citalopram dosage 2, 3.
Efficacy in Major Depressive Disorder (MDD)
- Escitalopram produced significantly greater improvements in standard measurements of antidepressant effect than placebo in several 8-week, placebo-controlled, randomised, double-blind, multicentre studies 2.
- It demonstrated a rapid onset of antidepressant action, with some parameters improving within 1-2 weeks of starting escitalopram treatment 2, 3.
- Escitalopram was generally more effective than placebo, at least as effective as citalopram, and generally at least as effective as other comparator drugs in adult patients with MDD in short-term, well-designed trials 3, 4.
Efficacy in Anxiety Disorders
- Escitalopram was effective and well-tolerated for the treatment of generalized anxiety disorder (GAD) 5.
- It showed significant improvements in patients with GAD, social anxiety disorder, and panic disorder treated with escitalopram for 8-12 weeks in individual, randomised, placebo-controlled, double-blind investigations 2.
Tolerability and Safety
- The good tolerability profile of escitalopram is predictable and similar to that of RS-citalopram 2.
- Adverse events such as nausea, ejaculatory problems, diarrhoea, and insomnia are expected, but with the exception of ejaculatory problems and nausea, these were generally no more frequent than with placebo in fully published clinical trials 2, 6.
- Escitalopram has a low propensity for drug interactions, a potential benefit in the management of patients with comorbidities 2, 4.