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Escitalopram Decreases Symptoms of Major Depressive Disorder in Adolescents: Presented at AACAP

By Deborah Brauser

HONOLULU -- November 6, 2009 -- Escitalopram significantly decreases key depression symptoms in adolescents aged 12 to 17 years with major depressive disorder (MDD), according to a post hoc analysis presented at the American Academy of Child and Adolescent Psychiatry (AACAP) 56th Annual Meeting.

The results of the study were presented by lead author Adelaide Robb, MD, Children's National Medical Center, Washington, DC, during a poster session on October 29.

In the original trial, 312 patients with MDD, as defined by the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), were randomly assigned to receive either escitalopram 10 to 20 mg daily (n = 155) or a matching placebo (n = 157) for 8 weeks to evaluate the treatment effect on the Children's Depression Rating Scale-Revised (CDRS-R) total score. Their findings showed that escitalopram reduced symptoms significantly from baseline to endpoint with a total score of -22.1 versus -18.8 for placebo.

For this secondary analysis, the investigators examined subscale scores from the CDRS-R in the areas of mood, behaviour, subjective, and somatic.

Results showed that the group treated with escitalopram had a significantly improved CDRS-R mood subscale score of -6.4 compared with -5.0 for the placebo-treated group (P < .01) and a significantly improved behaviour subscale score of -5.7 versus -4.8, respectively (P < .05). There were no significant differences found in either the subjective or somatic subscale scores.

In additional analysis, the investigators evaluated the 17-item CDRS-R questionnaire itself, to ascertain whether certain questions are better predictors for drug/placebo differences.

"We found that there are actually only 5 questions that you need to ask to get a real answer of whether the medicine is working," said Dr. Robb. "These are: Are you angry or irritable? Do you feel sad? Do you want to do things with your buddies? And when you do things, do you enjoy them or do you have difficulty having fun? And finally, while observing the patient, the clinician asks: Do you look sad? Those 5 questions out of the whole 17 items are the ones that made the difference in medicine versus placebo."

She reported that items associated with adult depression, such as sleep patterns, appetite, tiredness, and aches, showed no differences between the 2 treatments in children.

"It really boiled down to: are you having fun with your friends? Are you angry or sad? And how do you look? And that would make it very easy in a busy office practice if you had kids on an antidepressant to track improvement by asking only these 5 questions in this step-along questionnaire," concluded Dr. Robb.

Funding for this study was provided by Forest Laboratories, Inc.

[Presentation title: CDRS-R Subscale Analysis in a Randomized Placebo-Controlled Trail of Escitalopram in Depressed Adolescents. Abstract P-3.49]

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