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“Safe and effective” sounds like a promise, but what if it’s just a marketing stamp pasted over weak benefit and loud safety signals? We sit down with psych nurse David Wayne (Describe Health on X) to dissect the Strawn et al. clinical trial that helped push Lexapro (escitalopram) for pediatric anxiety and to ask the question parents deserve answered: what does “works” mean if the child doesn’t actually feel better?

We dig into how anxiety outcomes are measured using tools like the Pediatric Anxiety Rating Scale (PARS), why conflicts of interest should be a first-stop red flag, and how an eight-week SSRI study can claim success on a 1.4-point difference even when a 4-point change is what’s considered clinically noticeable. We also translate the stats tricks that confuse the public, including number needed to treat and the way relative risk versus absolute risk can completely change how a headline sounds.

Then we get into the harms that don’t fit on the glossy label: suicidality signals (9.5% on Lexapro vs 1.5% on placebo, including a suicide attempt), “activation syndrome” that can resemble akathisia, and why sexual side effects and Post-SSRI Sexual Dysfunction (PSSD) are too often omitted, minimized, or blamed on the patient. David also shares real advocacy wins, including pushing UpToDate to add PSSD as a class warning for SSRI and SNRI antidepressants, plus a jaw-dropping tapering problem where discontinuation claims don’t match what actually happened.

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