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Decreased growth during therapy with selective serotonin reuptake inhibitors
Naomi Weintrob1, Daniela Cohen, Yaffa Klipper-Aurbach
1Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petah Tikva 49202, Israel. nweintrob@clalit.org.il
Insights
Selective serotonin reuptake inhibitors (SSRIs) may decrease growth rate in children by suppressing growth hormone secretion. Discontinuation of SSRIs can lead to normal growth, suggesting a reversible effect.
Area of Science:
- Pediatric Endocrinology
- Child Psychiatry
- Pharmacology
Background:
- Limited data exists on the impact of selective serotonin reuptake inhibitors (SSRIs) on pediatric growth and puberty.
- This study investigates the effects of SSRIs on growth and growth hormone secretion in children with psychiatric disorders.
Observation:
- Four children (3 male, aged 11.6–13.7 years) with obsessive-compulsive disorder or Tourette syndrome were treated with SSRIs for 6 months to 5 years.
- Growth, pubertal progression, and hypothalamic-pituitary axis function were monitored.
Findings:
- All four patients experienced growth attenuation, with three showing growth retardation during anticipated pubertal growth spurts.
- Three patients exhibited decreased growth hormone response to stimulation tests, and one showed reduced 24-hour growth hormone secretion that normalized post-SSRI discontinuation.
- Two patients resumed normal growth after discontinuing SSRIs, while two others required somatropin therapy alongside continued SSRI treatment.
Implications:
- SSRI therapy may lead to decreased growth rates in children, potentially due to suppressed growth hormone secretion.
- Further research with larger cohorts is necessary to confirm these findings and understand the long-term effects of SSRIs on pediatric growth.
- These findings are crucial given the increasing use of SSRIs in pediatric populations.
Background:
There is no information on the effects of selective serotonin reuptake inhibitors (SSRIs) on growth and puberty in children. We examined growth and growth hormone secretion in 4 children treated with SSRIs for various psychiatric disorders.
Design:
Case study.
Participants:
Four children (3 boys) aged 11.6 to 13.7 years with obsessive-compulsive disorder or Tourette syndrome.
Main Outcome Measures:
Growth, pubertal progression, and hypothalamic pituitary function.
Methods:
The patients were treated with SSRIs for 6 months to 5 years (dosage, 20-100 mg/d). All were regularly examined for changes in height and bone age and for pubertal progression. They also underwent evaluation of somatotrophic axis and hypothalamic-pituitary axis function.
Results:
All 4 patients had growth attenuation. Three of them exhibited growth retardation at a pubertal stage when a growth spurt was anticipated. Three had a decreased growth hormone response to clonidine hydrochloride stimulation and 2 to both clonidine and glucagon stimulation, and 1 had decreased 24-hour secretion of growth hormone that normalized when therapy was stopped. The rest of the endocrine evaluations were within reference ranges in all patients. At follow-up, 2 patients were being treated with somatropin while continuing SSRI therapy, and the other 2 resumed normal growth after discontinuation of therapy.
Conclusions:
A decrease in growth rate, possibly secondary to suppression of growth hormone secretion, may occur during SSRI therapy. As the use of this group of drugs is expected to increase in the young age groups, larger studies are warranted to investigate their effect on growth and growth hormone secretion.