Decreased growth during therapy with selective serotonin reuptake inhibitors.

[balls]

Decreased growth during therapy with selective serotonin reuptake inhibitors.

Weintrob N, Cohen D, Klipper-Aurbach Y, Zadik Z, Dickerman Z.
Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petah Tikva 49202, Israel. [email protected]
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 ******ation 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.
PMID: 12090838 [PubMed - indexed for MEDLINE]

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[Doc Samson]

An N of 4? Really? Quick... call the FDA, let's get that black box out there ASAP!

 

[balls]

An N of 4? Really? Quick... call the FDA, let's get that black box out there ASAP!

This is a case study, not a clinical trial, and its findings are very revealing. It is wholly unfair and irresponsible to dismiss this research simply because the number of participants is small. The value of small case studies like this is that they can catch things that large clinical trials are prone to miss.

100% of subjects - 4 out of 4 - had stunted growth. 100% of subjects - 2 out of 2 - resumed normal growth after discontinuation. That's a pretty impressive result.

The FDA would faithfully advocate for big pharma in any case.

 

[Faebinder]

Not only do I shake my head when I see the n=4.... I express further concerns about the validity of the study when there are no controls.

This study would have been valid if it was compared to 4 other kids of similar age not taking SSRIs. There are all sorta of issues you need the control for such as: How do you know that your method of detection is adequate? What if your likely chance of detecting growth was low to begin with? You would never know without a control. A control would build up the numbers to do a Fisher's exact test.

This study is not even close to being conclusive.

 

[tr]

Not only do I shake my head when I see the n=4.... I express further concerns about the validity of the study when there are no controls...
This study is not even close to being conclusive.

It's not at all conclusive, but it's certainly suggestive.

That's the way clinical research works. First you find a couple of case reports (which by definition do not have strict controls), then you do a pilot study, then if your effect holds up you move into increasingly larger and more exactingly designed trials.

Obviously this is not the Framingham heart study. It's nonetheless rather shortsighted to dismiss it altogether, rather than consider it worthy of further investigation.

I'd be more surprised if SSRIs did *not* have far-reaching effects on the growth and development of children who receive them. Catecholamines do a lot of other things besides make you feel good.

 

[worriedwell]

could one argue from this study that untreated ocd and tourettes may be related to growth hormone dysregulation and the treatment for OCD stabilizes that hormone which may be what is partially responsible for the syndromes (and still may have side effects). of course, you could argue it, as you could argue a lot of things about why these results are so.

i think the point is that a study like this is hypothesis generating potentially and good for further investigation, but by no means a call to arms against ssris in children. that being said, all drugs need to be evaluated for risk/benefit analysis and we often are very loosey goosey with our ssri use because over the past 20 years they have stood the test of time in adults (but now in elderly there is concern over decreased bone density). however, extrapolating to children and assuming they are just little adults is flawed and should be heavily scrutinized. their brains and biology is different and altering that can certainly have permanent consequences (sometimes for the better in the case of successful treatments, but sometimes for the worse as well with collateral damage of the treatments).

 

[Faebinder]

Again, without a control, I find it difficult to pay attention to the study. Maybe if a known mechanism is proposed. I will admit it makes a nice research topic but n = 4 with no control is like not worthy of mention despite potential. For all you know, this could be a simple artifact of their measuring test (and without a control, you cant tell).

 

[whopper]

It's nonetheless rather shortsighted to dismiss it altogether, rather than consider it worthy of further investigation.

At best.

I'm not sure if "balls" was banned for this particular post. If so, I don't agree because nothing alarmist was written.

However I also want to point out that there is documentation that depression also causes slowdown of growth & OCD.

So these kids may have had stunted growth not so much because of the SSRIs if at all. It could've been due to their psyche disorder.

Also, growth is not a continuous & steady process. It has spurts, highs & lows. Some kids are the shortest in their class for several years, then bam! out of nowhere, they're the tallest. We all had to memorize the growth patterns of kids in medical school during Pediatrics so we ought to know this.

And from medical school--Statistics-4 kids is certainly not a good number. 25 isn't even a good number, but with the sometimes chaotic nature of growth, this study barely makes a difference in my own opinion.

Does it warrant further study? Sure, but its not exactly even a strong argument to pursue a further study--its a weak one.

More children today are on psychotropic meds, so the effects of meds should be studied on children. I certainly don't mind more research in this area, I welcome it, but this study barely indicates anything.

 

[Anasazi23]

At best.

I'm not sure if "balls" was banned for this particular post. If so, I don't agree because nothing alarmist was written.

We don't ban people for reasonable free expression of ideas...and I express reasonable. This was a reincarnated troll account.

 

[Faebinder]

Speaking of account.. don't I get that 2 year+ badge now?

 

[whopper]

We don't ban people for reasonable free expression of ideas...and I express reasonable. This was a reincarnated troll account

Well if anything Anasazi, you have been a great moderator & I've come to trust you & several others on the board such as Doc Samson, OldPsycheDoc among several others. Years of thoughtful & intelligent posts mean something.

As for Faebinder--I know that guy and and quite glad that he's coming to my program.

There's plenty of others. I had good confidence that if Balls was banned there must've been some reason.

A correction on my previous comment.

However I also want to point out that there is documentation that depression also causes slowdown of growth & OCD.

There is documentation that Depression or OCD can slow growth, not growth & OCD. Sorry about that. I sometimes type faster than I think.

So if anything that even further weakens this study. Anyone with OCD should've been expected to grow more slowly anyways.

 

[Faebinder]

As for Faebinder--I know that guy and quite glad that he's coming to my program.

Four weeks baby!!!!!

(No, I'm not referring to wearing speedos!)