Citalopram in Child and Adolescent Depression With Anxiety

James L. Schaller, MD, David Behar, MD

In This Article


The paucity of selective serotonin reuptake inhibitor (SSRI) studies in child and adolescent psychiatry represents a serious frustration for clinicians treating youth with major depression (MD). We report 4 cases illustrating citalopram's low rate of anxiety symptoms or low "activation," an important consideration in medication choice. Youth may resist further medication treatment if they experience iatrogenic activation or increased anxiety.

Citalopram has been in use outside the United States since 1989, is approved for use in 69 countries, and is the most selective SSRI.[1,2] In terms of anxiety side effects, citalopram demonstrated less need for concomitant anxiolytics/hypnotics vs fluoxetine in average doses.[3] Citalopram had a low rate of activation (only a 0.4% to 1.4% increase above placebo on 4 separate anxiety measures[4]), along with strong anxiolytic effects in adults.[5,6] In contrast to less selective SSRIs, it has not been reported to produce the dysphoria of akathisia.[7,8,9,10,11,12,13,14,15] Further, citalopram resulted in better patient compliance during initiation of treatment compared with sertraline, with superior anxiolytic benefit.[16] Citalopram treatment of youth anxiety demonstrates an antianxiety benefit with minimal activation/anxiety on initiation.[17,18,19,20] Yet, currently, there are no child or adolescent head-to-head SSRI anxiety studies in children. This case series is meant to raise the question: do all SSRIs share the same rates of initial anxiety and activation side effects?


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