Lexapro Use in Adolescents

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Lexapro Use in Adolescents

Question:

Is Lexapro an appropriate drug to give to a 15-year-old? I have read that it has not been tested in teenagers. Is there another drug that is more acceptable?

Answer:

Lexapro is the brand name of the drug escitalopram. It is a Selective Serotonin Reuptake Inhibitor (SSRI) antidepressant.

You are — for the most part — right that Lexapro has not been formally tested in teens.

All medical treatments have potential side effects, but parents are appropriately concerned about giving psychiatric medications to their children. In many instances, drug treatment is appropriate and beneficial, but you should be aware of a few significant points.

A child's brain develops rapidly through adolescence and beyond. All "psychoactive" drugs influence brain function. Though many drugs affect the brain in very helpful ways, we still have a lot to learn about the short-term and long-term effects of the drugs.

A very specific worry has come up in the past several years about prescribing antidepressants to kids. There is some evidence that children who are given an antidepressant develop suicidal thoughts or behavior, including suicide attempts, at a higher rate than children given a placebo (a fake or inactive pill).

This observation led the Food and Drug Administration (FDA) to issue a prominent warning about prescribing antidepressants. The warning advises that parents and doctors be on the alert for any change in thinking, mood, or behavior, especially during the first month of treatment.

The FDA has only approved fluoxetine for use in children with depression. Fluoxetine is the generic name for Prozac.

However, psychiatrists do prescribe other antidepressants for children. This is a legal practice known as "off-label" use. This kind of prescribing provides relief to many people.

There is much off-label use because drug companies usually do not want to spend the money to pursue FDA approval for a new use. They avoid the expense of doing the research and taking the drug through the approval process.

Another reason that more antidepressants are not FDA-approved in children is that it is difficult to research the effectiveness of psychiatric medications in children. For the same reason that parents are concerned about starting their children on drug treatments, they are even more reluctant to enroll them in research programs.

But the consequences of NOT treating a psychiatric illness like depression in a child can be much worse than the risk of giving an antidepressant. The illness can lead to suicidal thinking and behavior, or may hamper a child's growth and happiness.

Since fluoxetine does carry the FDA approval, many child psychiatrists recommend that medicine first in children. If fluoxetine doesn't help, then it is reasonable to try other options. Sometimes a doctor may suggest an alternative to fluoxetine at the start.

Michael Craig Miller, M.D., is editor-in-chief of the Harvard Mental Health Letter and an assistant professor of psychiatry at Harvard Medical School. Dr. Miller has an active clinical practice and has been on staff at Beth Israel Deaconess Medical Center for more than 25 years.

Last updated:	July 20, 2009