Skip to main content
SpringerLink
Log in

Effectiveness and tolerability of citalopram for the treatment of depression and anxiety disorders in children and adolescents: an open-label study

  • Biological Child and Adolescent Psychiatry - Original Article
  • Published:
Journal of Neural Transmission Aims and scope Submit manuscript

Abstract

To assess the effectiveness and tolerability of citalopram for the acute treatment of children and adolescents suffering from depression and/or anxiety disorders. As much as 78 outpatients, aged 7–18 years with a diagnosis of depressive and/or anxiety disorder, completed an 8-week open trial with citalopram (20–40 mg/day). Outcome, side effects and suicidality were assessed weekly to bi-weekly using appropriate rating scales. At endpoint 56% of subjects were found to be responders (Clinical Global Impression-Improvement [CGI-I] Scale ≤ 2). Subjects with less severe psychopathology and subjects with anxiety disorders showed a more favorable response. As much as 43% of depressed and 51% of anxious subjects had a 50% or greater reduction in scores on our secondary outcome measures, Children’s Depression Rating Scale-Revised (CDRS-R) and Screen for Child Anxiety Related Emotional Disorders (SCARED). Most reported adverse events were mild to moderate and did not affect medication adherence. No increase in suicidality was observed during the study. Citalopram was moderately effective, generally well tolerated and safe for the acute treatment of depressed and anxious children and adolescents.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Ambrosini PJ, Metz C, Bianchi MD, Rabinovich H, Undie A (1991) Concurrent validity and psychometric properties of the Beck Depression Inventory in outpatient adolescents. J Am Acad Child Adolesc Psychiatry 30:51–57

    Article  CAS  PubMed  Google Scholar 

  • Ambrosini PJ, Wagner KD, Biederman J, Glick I, Tan C, Elia J, Hebeler JR, Rabinovich H, Lock J, Geller D (1999) Multicenter open-label sertraline study in adolescent outpatients with major depression. J Am Acad Child Adolesc Psychiatry 38:566–572

    Article  CAS  PubMed  Google Scholar 

  • Apter A, Kronenberg S, Brent D (2005) Turning darkness into light. A new landmark study on the treatment of adolescent depression. Comments on the TADS study. Eur Child Adolesc Psychiatry 14:113–116

    Article  PubMed  Google Scholar 

  • Baumgartner JL, Emslie GJ, Crismon ML (2002) Citalopram in children and adolescents with depression or anxiety. Ann Pharmacother 36:1692–1697

    Article  CAS  PubMed  Google Scholar 

  • Beasley CM Jr, Dornseif BE, Bosomworth JC, Sayler ME, Rampey AH Jr, Heiligenstein JH, Thompson VL, Murphy DJ, Masica DN (1991) Fluoxetine and suicide: a meta-analysis of controlled trials of treatment for depression. BMJ 303:685–692

    Article  PubMed  Google Scholar 

  • Bernstein GA, Shaw K (1997) Practice parameters for the assessment and treatment of children and adolescents with anxiety disorders American Academy of Child and Adolescent Psychiatry. J Am Acad Child Adolesc Psychiatry 36:69S–84S

    CAS  PubMed  Google Scholar 

  • Birmaher B, Khetarpal S, Brent D, Cully M, Balach L, Kaufman J, Neer SM (1997) The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry 36:545–553

    Article  CAS  PubMed  Google Scholar 

  • Birmaher B, Brent DA, Chiappetta L, Bridge J, Monga S, Baugher M (1999) Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry 38:1230–1236

    Article  CAS  PubMed  Google Scholar 

  • Birmaher B, Axelson DA, Monk K, Kalas C, Clark DB, Ehmann M, Bridge J, Heo J, Brent DA (2003) Fluoxetine for the treatment of childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry 42:415–423

    PubMed  Google Scholar 

  • Brent DA (1993) Depression and suicide in children and adolescents. Pediatr Rev 14:380–388

    Article  CAS  PubMed  Google Scholar 

  • Bridge JA, Iyengar S, Salary CB, Barbe RP, Birmaher B, Pincus HA, Ren L, Brent DA (2007) Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA 297:1683–1696

    Article  CAS  PubMed  Google Scholar 

  • Compton SN, Grant PJ, Chrisman AK, Gammon PJ, Brown VL, March JS (2001) Sertraline in children and adolescents with social anxiety disorder: an open trial. J Am Acad Child Adolesc Psychiatry 40:564–571

    Article  CAS  PubMed  Google Scholar 

  • Emslie GJ, Rush AJ, Weinberg WA, Kowatch RA, Hughes CW, Carmody T, Rintelmann J (1997) A double-blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression. Arch Gen Psychiatry 54:1031–1037

    CAS  PubMed  Google Scholar 

  • Emslie GJ, Rush AJ, Weinberg WA, Kowatch RA, Carmody T, Mayes TL (1998) Fluoxetine in child and adolescent depression: acute and maintenance treatment. Depress Anxiety 7:32–39

    Article  CAS  PubMed  Google Scholar 

  • Emslie GJ, Heiligenstein JH, Wagner KD, Hoog SL, Ernest DE, Brown E, Nilsson M, Jacobson JG (2002) Fluoxetine for acute treatment of depression in children and adolescents: a placebo-controlled, randomized clinical trial. J Am Acad Child Adolesc Psychiatry 41:1205–1215

    Article  PubMed  Google Scholar 

  • Emslie GJ, Ryan ND, Wagner KD (2005) Major depressive disorder in children and adolescents: clinical trial design and antidepressant efficacy. J Clin Psychiatry 66(Suppl 7):14–20

    CAS  PubMed  Google Scholar 

  • Emslie G, Kratochvil C, Vitiello B, Silva S, Mayes T, McNulty S, Weller E, Waslick B, Casat C, Walkup J, Pathak S, Rohde P, Posner K, March J (2006a) Treatment for Adolescents with Depression Study (TADS): safety results. J Am Acad Child Adolesc Psychiatry 45:1440–1455

    Article  PubMed  Google Scholar 

  • Emslie GJ, Wagner KD, Kutcher S, Krulewicz S, Fong R, Carpenter DJ, Lipschitz A, Machin A, Wilkinson C (2006b) Paroxetine treatment in children and adolescents with major depressive disorder: a randomized, multicenter, double-blind, placebo-controlled trial. J Am Acad Child Adolesc Psychiatry 45:709–719

    Article  PubMed  Google Scholar 

  • Fairbanks JM, Pine DS, Tancer NK, Dummit ES 3rd, Kentgen LM, Martin J, Asche BK, Klein RG (1997) Open fluoxetine treatment of mixed anxiety disorders in children and adolescents. J Child Adolesc Psychopharmacol 7:17–29

    Article  CAS  PubMed  Google Scholar 

  • Fergusson D, Doucette S, Glass KC, Shapiro S, Healy D, Hebert P, Hutton B (2005) Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomised controlled trials. BMJ 330:396

    Article  CAS  PubMed  Google Scholar 

  • Guy W (1976) Clinical global improvement scale. In: Assessment manual of psychopharmacology. National Institute of Mental Health, Rockville

  • Hamilton JD, Bridge J (1999) Outcome at 6 months for 50 adolescents with major depression treated in a health maintenance organization. J Am Acad Child Adolesc Psychiatry 38:1340–1346

    Article  CAS  PubMed  Google Scholar 

  • Hammad TA, Laughren T, Racoosin J (2006) Suicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry 63:332–339

    Article  CAS  PubMed  Google Scholar 

  • Hemeryck A, Belpaire FM (2002) Selective serotonin reuptake inhibitors and cytochrome P-450 mediated drug-drug interactions: an update. Curr Drug Metab 3:13–37

    Article  CAS  PubMed  Google Scholar 

  • Jick SS, Dean AD, Jick H (1995) Antidepressants and suicide. BMJ 310:215–218

    CAS  PubMed  Google Scholar 

  • Jick H, Kaye JA, Jick SS (2004) Antidepressants and the risk of suicidal behaviors. JAMA 292:338–343

    Article  CAS  PubMed  Google Scholar 

  • Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–988

    Article  CAS  PubMed  Google Scholar 

  • Keller MB (2000) Citalopram therapy for depression: a review of 10 years of European experience and data from U.S. clinical trials. J Clin Psychiatry 61:896–908

    CAS  PubMed  Google Scholar 

  • Keller MB, Ryan ND, Strober M, Klein RG, Kutcher SP, Birmaher B, Hagino OR, Koplewicz H, Carlson GA, Clarke GN, Emslie GJ, Feinberg D, Geller B, Kusumakar V, Papatheodorou G, Sack WH, Sweeney M, Wagner KD, Weller EB, Winters NC, Oakes R, McCafferty JP (2001) Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 40:762–772

    Article  CAS  PubMed  Google Scholar 

  • Kennard B, Silva S, Vitiello B, Curry J, Kratochvil C, Simons A, Hughes J, Feeny N, Weller E, Sweeney M, Reinecke M, Pathak S, Ginsburg G, Emslie G, March J (2006) Remission and residual symptoms after short-term treatment in the Treatment of Adolescents with Depression Study (TADS). J Am Acad Child Adolesc Psychiatry 45:1404–1411

    Article  PubMed  Google Scholar 

  • Khan A, Khan S, Kolts R, Brown WA (2003) Suicide rates in clinical trials of SSRIs, other antidepressants, and placebo: analysis of FDA reports. Am J Psychiatry 160:790–792

    Article  PubMed  Google Scholar 

  • Kronenberg S, Apter A, Brent D, Schirman S, Melhem N, Pick N, Gothelf D, Carmel M, Frisch A, Weizman A (2007) Serotonin transporter polymorphism (5-HTTLPR) and citalopram effectiveness and side effects in children with depression and/or anxiety disorders. J Child Adolesc Psychopharmacol 17:741–750

    Article  PubMed  Google Scholar 

  • Lim CJ, Leckman JF, Young C, Martin A (2005) Antidepressant-induced manic conversion: a developmentally informed synthesis of the literature. Int Rev Neurobiol 65:25–52

    Article  CAS  PubMed  Google Scholar 

  • Lucki I, O’Leary OF (2004) Distinguishing roles for norepinephrine and serotonin in the behavioral effects of antidepressant drugs. J Clin Psychiatry 65(Suppl 4):11–24

    CAS  PubMed  Google Scholar 

  • March J, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, Burns B, Domino M, McNulty S, Vitiello B, Severe J (2004) Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. JAMA 292:807–820

    Article  CAS  PubMed  Google Scholar 

  • Poznanski E, Freeman LN, Mokros H (1985) Children’s depression rating scale-revised. J Psychopharmacol Bull 21:979–989

    Google Scholar 

  • Reynolds W (1987) Suicide ideation questionnaire. Psychological Assessment Resources, Odessa

    Google Scholar 

  • Shanee N, Apter A, Weizman A (1997) Psychometric properties of the K-SADS-PL in an Israeli adolescent clinical population. Isr J Psychiatry Relat Sci 34:179–186

    CAS  PubMed  Google Scholar 

  • Shirazi E, Alaghband-Rad J (2005) An open trial of citalopram in children and adolescents with depression. J Child Adolesc Psychopharmacol 15:233–239

    Article  PubMed  Google Scholar 

  • Simeon JG (1989) Depressive disorders in children and adolescents. Psychiatr J Univ Ott 14:356–361 discussion 362–363

    CAS  PubMed  Google Scholar 

  • Smucker MR, Craighead WE, Craighead LW, Green BJ (1986) Normative and reliability data for the children’s depression inventory. J Abnorm Child Psychol 14:25–39

    Article  CAS  PubMed  Google Scholar 

  • Tao R, Emslie G, Mayes T, Nakonezny P, Kennard B, Hughes C (2009) Early prediction of acute antidepressant treatment response and remission in pediatric major depressive disorder. J Am Acad Child Adolesc Psychiatry 48(1):71–78

    Article  PubMed  Google Scholar 

  • Teicher MH, Glod CA, Cole JO (1993) Antidepressant drugs and the emergence of suicidal tendencies. Drug Saf 8:186–212

    Article  CAS  PubMed  Google Scholar 

  • Tsapakis EM, Soldani F, Tondo L, Baldessarini RJ (2008) Efficacy of antidepressants in juvenile depression: meta-analysis. Br J Psychiatry 193(1):10–17

    Article  PubMed  Google Scholar 

  • Vitiello B, Swedo S (2004) Antidepressant medications in children. N Engl J Med 350:1489–1491

    Article  CAS  PubMed  Google Scholar 

  • von Knorring AL, Olsson GI, Thomsen PH, Lemming OM, Hulten A (2006) A randomized, double-blind, placebo-controlled study of citalopram in adolescents with major depressive disorder. J Clin Psychopharmacol 26:311–315

    Article  CAS  PubMed  Google Scholar 

  • Wagner KD, Ambrosini P, Rynn M, Wohlberg C, Yang R, Greenbaum MS, Childress A, Donnelly C, Deas D (2003) Efficacy of sertraline in the treatment of children and adolescents with major depressive disorder: two randomized controlled trials. JAMA 290:1033–1041

    Article  CAS  PubMed  Google Scholar 

  • Wagner KD, Berard R, Stein MB, Wetherhold E, Carpenter DJ, Perera P, Gee M, Davy K, Machin A (2004a) A multicenter, randomized, double-blind, placebo-controlled trial of paroxetine in children and adolescents with social anxiety disorder. Arch Gen Psychiatry 61:1153–1162

    Article  CAS  PubMed  Google Scholar 

  • Wagner KD, Robb AS, Findling RL, Jin J, Gutierrez MM, Heydorn WE (2004b) A randomized, placebo-controlled trial of citalopram for the treatment of major depression in children and adolescents. Am J Psychiatry 161:1079–1083

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study has been approved by the local ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. This work was supported by the National Institute for Psychobiology in Israel (Grant No. 2006-2), Adams Super Center for Brain Research (Tel Aviv University), the Klingenstein Third Generation Foundation and a National Alliance for Research and Schizophrenia and Depression (NARSAD) Young Investigator Award (Dr. Melhem), and a NARSAD Distinguished Investigator Award (Dr. Brent).

Conflict of interest statement

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Feinberg Child Study Center, Schneider Children’s Medical Center of Israel and Sackler Faculty of Medicine, Tel Aviv University, 14 Kaplan Street, 49202, Petach-Tikva, Tel Aviv, Israel

    Shella Schirman, Sefi Kronenberg, Alan Apter, Nimrod Pick & Doron Gothelf

  2. Department of Child and Adolescent Psychiatry, Goethe-University, Deutschordenstraße 50, 60528, Frankfurt/Main, Germany

    Shella Schirman

  3. Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    David Brent & Nadine Melhem

  4. Felsenstein Medical Research Center and Research Unit at Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Beilinson Campus, Petah Tikva, Tel Aviv, Israel

    Miri Carmel, Amos Frisch & Abraham Weizman

Authors
  1. Shella Schirman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sefi Kronenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alan Apter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Brent
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nadine Melhem
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nimrod Pick
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Miri Carmel
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Amos Frisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Abraham Weizman
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Doron Gothelf
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shella Schirman.

Additional information

S. Schirman and S. Kronenberg contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schirman, S., Kronenberg, S., Apter, A. et al. Effectiveness and tolerability of citalopram for the treatment of depression and anxiety disorders in children and adolescents: an open-label study. J Neural Transm 117, 139–145 (2010). https://doi.org/10.1007/s00702-009-0330-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00702-009-0330-x

Keywords

Search

Navigation