Comparison of Lexapro (Escitalopram) vs Celexa (Citalopram) for Children
Lexapro (escitalopram) is preferred over Celexa (citalopram) for children due to its better safety profile, particularly regarding QT prolongation risk and fewer drug interactions. 1
Safety Profile Comparison
Cardiac Safety
- Citalopram has a boxed warning not to exceed doses of 40 mg per day in adults (20 mg in adults over 60) due to dose-dependent QT prolongation risk, which can lead to potentially fatal arrhythmias 1
- Both citalopram and escitalopram can cause QT prolongation, but the risk appears more significant with citalopram, making escitalopram a safer choice for children 1
Drug Interactions
- Escitalopram has less effect on CYP450 isoenzymes compared to other SSRIs, resulting in a lower propensity for drug interactions 1
- Citalopram may interact with drugs that prolong the QT interval, increasing cardiac risk 1
- Fluoxetine, paroxetine, and sertraline may interact with drugs metabolized by CYP2D6, while fluvoxamine has multiple potential interactions with drugs metabolized by various CYP enzymes 1
Efficacy Considerations
Depression Treatment
- Escitalopram has demonstrated efficacy in adolescents with major depressive disorder in clinical trials 2
- Escitalopram shows more rapid onset of action compared to citalopram at half the dosage 3, 4
- In severe depression, escitalopram has shown superior efficacy compared to citalopram 4
Anxiety Treatment
- Both medications can be effective for anxiety disorders, which are common comorbidities in children with depression 1
- SSRIs as a class have shown efficacy for treating anxiety disorders in children and adolescents aged 6-18 years 1
Administration and Dosing
- For children, starting with a subtherapeutic "test" dose is advisable as SSRIs can initially increase anxiety or agitation 1
- Escitalopram has linear pharmacokinetics, making dosing more predictable 5
- For shorter half-life SSRIs like citalopram, dose increases should be made at 1-2 week intervals, while longer half-life SSRIs may require 3-4 week intervals 1
- Parental oversight of medication regimens is critically important for children and adolescents 1
Adverse Effects
Common Side Effects
- Both medications may cause gastrointestinal symptoms, sleep disturbances, and sexual effects (in adolescents) 5, 6
- Nausea is the most common side effect with escitalopram, occurring in >10% of patients, but is typically mild and transient 5
Discontinuation Syndrome
- Citalopram has been associated with discontinuation syndrome 1
- Paroxetine, fluvoxamine, and sertraline have higher rates of discontinuation syndrome than escitalopram 1
Special Considerations for Children
Neonatal Exposure Risk
- If considering these medications for adolescent females who may become pregnant, both SSRIs have been associated with neonatal withdrawal symptoms 1
- Symptoms can include crying, irritability, tremors, feeding difficulties, and sleep disturbance 1
Suicidality Risk
- All antidepressants carry a black box warning about increased risk of suicidal thinking and behavior in children, adolescents, and young adults 1
- Close monitoring is essential, especially during the first 1-2 months of treatment or after dose increases 1
Conclusion
When choosing between Lexapro and Celexa for a child, Lexapro (escitalopram) offers several advantages:
- Lower risk of QT prolongation 1
- Fewer drug interactions 1
- More rapid onset of action 3, 4
- Better tolerability profile 5, 6
These factors make escitalopram the preferred choice over citalopram for pediatric patients requiring SSRI treatment.