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Decreased Growth During Therapy With Selective Serotonin Reuptake Inhibitors
Naomi Weintrob, MD;
Daniela Cohen, MD;
Yaffa Klipper-Aurbach, MSc;
Zvi Zadik, MD;
Zvi Dickerman, MD
Arch Pediatr Adolesc Med. 2002;156:696-701.
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.
From the Institute for Endocrinology and Diabetes, Schneider Children's
Medical Center of Israel, Petah Tikva, and Sackler School of Medicine, Tel
Aviv University, Tel Aviv (Drs Weintrob, Cohen, and Dickerman and Ms Klipper-Aurbach);
and Pediatric Endocrine Unit and Laboratory, Kaplan Medical Center, Rehovot
(Dr Zadik), Israel.
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