REVIEW OF: Calarge C et al, J Clin Psychopharmacol 2024;44(6):538–544
STUDY TYPE: Prospective cohort study

SSRIs are widely used in children and adolescents, but their effects on physical development are easy to overlook.

Researchers followed 66 youth ages 8–15 who had recently started fluoxetine or sertraline and compared them with 36 healthy, unmedicated controls. All participants were in mid-puberty (Tanner stages 2–4, by report), when growth velocity is highest. Height, weight, and BMI were tracked over six months, along with blood levels of IGF-1, a marker of growth hormone activity.

Youth taking SSRIs grew more slowly than controls, and the effect was dose-related. At typical therapeutic doses, height gain over six months was about 45% lower than expected. Higher SSRI exposure (40 mg fluoxetine or 100 mg sertraline) was linked to progressively smaller increases in height.

Markers of growth hormone signaling told a similar story. Higher SSRI doses were associated with lower IGF-1 levels, suggesting a biologic mechanism for the slowed growth. Weight changes were modest overall for both SSRIs (1.35 +/- 0.42). There were no meaningful differences between the two SSRIs in their effects on height.

CARLAT TAKE
This small, brief, but carefully done study adds to concerns that SSRIs may blunt pubertal growth, especially at higher doses. The effect isn’t subtle, and it lines up with changes in growth hormone signaling as a possible mechanism. For some kids, SSRIs are truly helpful. But treat growth like a vital sign, much as we do with stimulant medications. Track height over time, avoid unnecessary dose escalation, and reassess if growth velocity drops off. If growth suppression appears clinically meaningful, consider a dose reduction, an endocrine consult, or a medication switch to another SSRI, since SNRIs have limited value for kids and teens.