Section - CAP Smart Takes

05. Long-Term Efficacy of Escitalopram in Adolescents With Major Depressive Disorder

Published on April 1, 2024 Certification expiration date: April 1, 2027

David R. Rosenberg, M.D.

Chair of the Department of Psychiatry & Behavioral Neuroscience - Wayne State University School of Medicine

Key Points

This study did not demonstrate that escitalopram is superior to placebo in preventing relapse after 48 weeks of treatment compared with 12 weeks.
Results are not definitive due to limitations, such as high placebo response rates and lower-than-expected relapse rates in adolescents with MDD.

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Greetings, this is David Rosenberg. In this CAP—or Child and Adolescent Psychiatry—Smart Take, we will examine a crucial yet under-researched area in child and adolescent psychiatry—namely, the long-term efficacy of antidepressant treatment and its capability (or lack thereof) to prevent relapse in adolescents diagnosed with major depressive disorder (MDD). This topic is vital as, to date, pharmacotherapy for adolescents with major depressive disorder remains somewhat elusive. Currently, only 2 FDA-approved treatments exist for this disorder in youth: Fluoxetine and escitalopram. However, we know that many patients do not respond to these treatments at all or only respond partially, resulting in continued functional impairment.

The risk of relapse remains an open question: How long do patients stay well? This leads to the age-old questions that parents, teenagers, and clinicians want answered: How long does the patient need to be on medication? When is it safe to taper or discontinue? Is lifelong

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Learning Objectives:

Recognize that at 3-year follow-up, 3 in 4 pediatric patients with OCD were in clinical remission.
Recognize that although not statistically significant, combining probiotics with methylphenidate was associated with higher therapeutic efficacy in patients with ADHD.
Analyze the effectiveness of ECT in treating adolescents with severe depressive episodes and suicidality.
Recognize that studies to date support the safety of transcranial electrical stimulation and transcranial magnetic stimulation in children and adolescents.
Recognize that escitalopram was not superior to placebo for relapse prevention in adolescents with MDD.

Original Release Date: April 1, 2024

Expiration Date: April 1, 2027

Experts: David Rosenberg, M.D.

Medical Editor: Lorena Rodriguez, M.D.

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None of the faculty, planners, and reviewers for this educational activity have relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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