What is the use of Escitalopram (Selective Serotonin Reuptake Inhibitor - SSRI)?

From the Guidelines

Escitalopram is a commonly prescribed antidepressant medication that belongs to the selective serotonin reuptake inhibitor (SSRI) class, and its use is recommended for the treatment of anxiety disorders in children and adolescents, as well as adults, due to its efficacy and relatively favorable side effect profile 1.

Key Considerations for Escitalopram Use

• Escitalopram works by increasing serotonin levels in the brain by blocking its reabsorption, which helps regulate mood, anxiety, and other mental health symptoms.
• The medication usually takes 2-4 weeks to show full therapeutic effects, though some patients may notice improvements sooner.
• Common side effects include nausea, insomnia, sexual dysfunction, headache, and dry mouth, which often improve over time.
• Patients should not stop taking escitalopram abruptly as this can cause withdrawal symptoms; instead, the medication should be tapered gradually under medical supervision.
• Escitalopram should not be combined with monoamine oxidase inhibitors (MAOIs) or other serotonergic medications due to the risk of serotonin syndrome, a potentially serious condition.

Special Prescribing Considerations

• Citalopram, the parent compound of escitalopram, may cause QT prolongation associated with Torsade de Pointes, ventricular tachycardia, and sudden death at daily doses exceeding 40 mg/d and should be avoided in patients with long QT syndrome 1.
• Escitalopram may have the least effect on CYP450 isoenzymes compared with other SSRIs and as such may have a lower propensity for drug interactions 1.
• A discontinuation syndrome characterized by dizziness, fatigue, lethargy, and other symptoms has been reported following missed doses or acute discontinuation of SSRIs, including escitalopram 1.

Dosage and Administration

• Escitalopram is typically prescribed at starting doses of 10mg once daily for adults with depression or anxiety disorders, which can be increased to a maximum of 20mg daily if needed.
• For elderly patients or those with liver impairment, lower starting doses of 5mg are recommended.
• Medical education, training, and experience are necessary to safely and effectively prescribe antidepressant medications, including escitalopram 1.

Monitoring and Follow-up

• Systematic assessment of treatment response using standardized symptom rating scales can be considered as a supplement to clinical evaluation.
• Parental oversight of medication regimens is of paramount importance in children and adolescents 1.
• Close monitoring for suicidality is recommended by the FDA, especially in the first months of treatment and following dosage adjustments 1.

From the FDA Drug Label

Escitalopram tablets are prescription medicines used to treat depression It is important to talk with your healthcare provider about the risks of treating depression and also the risks of not treating it. Escitalopram tablets are also used to treat: • Major Depressive Disorder (MDD) • Generalized Anxiety Disorder (GAD)

The use of Escitalopram, a Selective Serotonin Reuptake Inhibator (SSRI), is to treat:

• Depression
• Major Depressive Disorder (MDD)
• Generalized Anxiety Disorder (GAD) 2

From the Research

Use of Escitalopram

• Escitalopram is used in the management of major depressive disorder (MDD) and anxiety disorders, including generalized anxiety disorder, social anxiety disorder, and panic disorder 3, 4, 5, 6, 7.
• It is a highly selective serotonin reuptake inhibitor (SSRI) that inhibits the reuptake of serotonin into presynaptic nerve endings, enhancing the activity of serotonin in the central nervous system 5, 6, 7.
• Escitalopram has been shown to be effective in reducing symptoms of depression and anxiety, with a rapid onset of action and a predictable tolerability profile 3, 4, 5, 6, 7.

Efficacy of Escitalopram

• Escitalopram has been found to be superior to placebo in reducing symptoms of depression and anxiety 3, 4, 5, 6, 7.
• It has been shown to be at least as effective as other SSRIs, such as citalopram, fluoxetine, paroxetine, and sertraline, as well as serotonin-noradrenaline reuptake inhibitors (SNRIs) like venlafaxine and duloxetine 4, 5, 6, 7.
• Escitalopram has also been found to have a preventive effect on MDD relapse and recurrence with long-term administration 5, 6.

Tolerability and Safety of Escitalopram

• Escitalopram has a predictable tolerability profile with generally mild to moderate and transient adverse events 3, 4, 5, 6, 7.
• The most common adverse events associated with escitalopram include nausea, ejaculatory problems, diarrhea, and insomnia 3, 4, 5, 6, 7.
• Escitalopram has a low propensity for drug interactions, making it a suitable option for patients with comorbidities 3, 4, 5, 6, 7.