Does Sertraline Impact Height in Teens?
Yes, sertraline can reduce height growth in adolescents in a dose-dependent manner, though the effect appears modest and primarily occurs at higher doses.
Evidence for Height Impact
The most recent and highest quality evidence comes from a 2024 prospective cohort study demonstrating that sertraline inhibits height growth during puberty in a dose-dependent fashion 1. This study of 8-15 year-olds in Tanner stages 2-4 found that after accounting for baseline height Z-score, sex, Tanner stage, and time, the interaction effect of dose by time was inversely associated with height Z-score (β = -0.18; 95% CI: -0.35, -0.02) 1. Importantly, compared with being unmedicated, SSRI treatment was associated with smaller growth in height (time × dose interaction effect β = -1.30; 95% CI: -2.52, -0.09) 1.
The mechanism appears to involve growth hormone signaling suppression, as sertraline dose was inversely associated with IGF-1 concentration (β = -63.5; 95% CI: -112.2, -14.7) 1.
Magnitude and Clinical Significance
However, the long-term SPRITES registry study (2023) found no significant changes in standardized height across 3 years of follow-up based on cumulative sertraline exposure 2. This large observational study of 941 pediatric patients aged 6-16 years found results "consistent with normal development" 2.
The FDA label acknowledges that regular monitoring of weight and growth is recommended if treatment is to be continued long-term in pediatric patients, noting that "there are no studies that directly evaluate the effects of long-term sertraline use on the growth, development, and maturation of children and adolescents" 3.
Weight Effects
Sertraline demonstrates mixed effects on weight 2, 1:
- The SPRITES study found a small positive association between sertraline exposure and standardized weight (p = 0.02), with mean changes of 0.02,0.03,0.16, and 0.17 standard deviations at months 3,6,30, and 36 respectively 2
- However, this was not reflected in BMI changes, which were not statistically significant 2
- The 2024 study found BMI Z-score increased more with sertraline (β = 0.35; 95% CI: 0.06,0.64), particularly compared to fluoxetine 1
- Short-term controlled trials showed approximately 1 kg weight loss compared to placebo in both children and adolescents 3
Clinical Monitoring Recommendations
Monitor height and weight at baseline and regularly throughout treatment 3:
- Approximately 7% of children experienced weight loss >7% of body weight in controlled trials 3
- The dose-dependent nature of height effects suggests using the lowest effective dose 1
- Effects appear more pronounced at higher doses (>100 mg/day) 2
Comparison to Other Medications
The height suppression effect is not unique to sertraline—fluoxetine shows similar effects without significant difference between the two SSRIs 1. This contrasts with stimulant medications for ADHD, which show more consistent and well-documented effects on height and weight reduction 4.
Clinical Decision-Making Algorithm
When prescribing sertraline to adolescents:
- Document baseline height, weight, and Tanner stage 3, 1
- Use the lowest effective dose (start 25-50 mg daily, titrate slowly) 4
- Monitor growth parameters every 3-6 months 3
- Consider alternative SSRIs if growth concerns emerge, though fluoxetine shows similar effects 1
- Weigh growth concerns against psychiatric benefits—untreated anxiety/depression carries significant morbidity 4
Important Caveats
- The clinical significance of modest height reductions must be balanced against the substantial benefits of treating anxiety and depression, which improve quality of life, reduce functional impairment, and decrease risks of suicidal events 4
- Most adverse effects of SSRIs, including appetite changes, emerge within the first few weeks and often resolve with continued treatment 4
- The number needed to treat for response is 3, far outweighing the number needed to harm of 143 for suicidal ideation 4