Browsing by Author "Maneeton P."

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    Efficacy and Safety of Escitalopram for Major Depressive Disorder in Children and Adolescents: A Systematic Review and Meta-Analysis with Age-Specific Findings
    (2026-01-01) Maneeton B.; Maneeton N.; Pojanapotha P.; Putthisri S.; Oon-arom A.; Karawekpanyawong N.; Kawilapat S.; Maneeton P.; Srichan K.; Maneeton B.; Mahidol University
    Objective: To evaluate the efficacy, acceptability, and safety of escitalopram for pediatric major depressive disorder (MDD) through a systematic review and meta-analysis. Methods: We searched Cochrane CENTRAL, CINAHL, PubMed, ClinicalTrials.gov, and Scopus (January 2001– October 2025) for randomized controlled trials comparing escitalopram with placebo in children and adolescents (ages 6–17) with MDD. The primary outcome was the change in the Children’s Depression Rating Scale-Revised (CDRS-R). Secondary outcomes included Clinical Global Impressions scores, response rates, and discontinuation rates. Two reviewers independently assessed the risk of bias using Cochrane tools. Random-effects meta-analysis was performed; certainty was evaluated using GRADE. Results: Three RCTs (664 participants) were identified: two acute trials (Wagner 2006, n=268; Emslie 2009, n=316) and one continuation trial (Saito 2023, n=80). Meta-analysis of acute trials included 572 participants (completion rates 81–82%). Escitalopram demonstrated small and borderline statistically significant improvements versus placebo: CDRS-R (weighted mean difference [WMD]=−2.46, 95% CI: −4.83 to −0.09, I2=0%; low certainty); CGI-Severity (WMD=−0.35, 95% CI: −0.57 to −0.12); CGAS (WMD=2.56, 95% CI: 0.37 to 4.75); non-response rates (relative risk=0.84, 95% CI: 0.72 to 0.98; number needed to treat=11). Overall discontinuation (RR=1.37, 95% CI: 0.97 to 1.93) and discontinuation due to adverse events (RR=1.88, 95% CI: 0.44 to 8.03) did not differ significantly (low to very low certainty). Continuation treatment did not significantly prevent relapse (p=0.051). Limitations: Universal industry sponsorship, high placebo response (52–53% by CGI-I ≤2 in original publications), mixed trial results, limited evidence for children ages 6–11, and lack of independent replication. Conclusion: Escitalopram demonstrates small and borderline statistically significant efficacy for adolescent MDD (aged 12–17 years). Short-term tolerability is acceptable; however, no definitive conclusion on long-term safety can be drawn, and evidence is insufficient to support use in children aged 6–11 years. It may be considered when fluoxetine is unsuitable, combined with psychosocial interventions and close monitoring. Further independent studies are needed. Registration: PROSPERO CRD42019141268.