The Effectiveness of using escitalopram in Pediatric GAD and the Methods to Predict the treatment response: a Systematic Review and Meta-analysis

Generalized Anxiety Disorder (GAD) is among the most prevalent mental health problems in children and adolescents. (SSRIs) are among the main treatment modalities that are used in pediatric anxiety. Escitalopram is an SSRI that is often used in the treatment of adult anxiety, However, the use, efficacy, prediction of an escitalopram treatment, and safety of escitalopram for pediatric anxiety are still being researched. Objective: In this study, we aim to address the knowledge gap regarding the efficacy, potential predictors, and safety of escitalopram in the treatment of pediatric generalized anxiety disorder. Methods: Electronic searches were conducted for randomized controlled trials evaluating the effectiveness and method of treatment prediction of escitalopram in GAD in pediatrics. Results: Five RCTs were eligible for the final analysis. The overall SMD between the escitalopram and the placebo on reduction of the PARS score favored the escitalopram (MD -6.1, 95% CI [-8.75 to -3.44] (P = 0.09, I2 = 65%). Furthermore, different methods were used to predict the escitalopram treatment response, such as changes in reaction time, executive functions, and Amygdala Functional Connectivity, as well as the CYP2C19 metabolizer phenotype. And the results suggested that neuroimaging is the best modality for predicting the treatment. response. Conclusion: The most obvious finding to emerge from this study is that escitalopram showed a clinically significant reduction in PARS score. In addition, neuroimaging is effective as a treatment response biomarker predictor, and it also can help in the deep understanding of the neuroanatomy and neurochemistry behind anxiety spectrum diseases.