SSRIs and Growth Suppression in Children and Adolescents
Growth suppression is not a recognized adverse effect of SSRIs in children and adolescents based on current guideline evidence and the highest quality prospective research. 1, 2
Evidence from Guidelines
The American Academy of Child and Adolescent Psychiatry's 2020 clinical practice guideline for anxiety disorders provides a comprehensive list of SSRI adverse effects in youth, including both common and serious complications 1. Notably absent from this extensive safety profile is any mention of growth suppression or height/weight effects. 1 The guideline specifically lists:
Common adverse effects: dry mouth, nausea, diarrhea, heartburn, headache, somnolence, insomnia, dizziness, vivid dreams, changes in appetite, weight loss or gain, fatigue, nervousness, tremor, bruxism, and diaphoresis 1
Serious adverse effects: suicidal thinking and behavior, behavioral activation/agitation, hypomania, mania, sexual dysfunction, seizures, abnormal bleeding, and serotonin syndrome 1
The U.S. Preventive Services Task Force 2016 guidelines on depression screening similarly reviewed SSRI safety data from five trials and found no evidence of growth-related adverse effects 1.
Highest Quality Prospective Evidence
The SPRITES study (2023) represents the most recent and highest quality evidence directly addressing this question. 2 This multicenter, prospective, 3-year observational study of 941 pediatric patients (ages 6-16 years) found:
- No significant changes in standardized height across time based on cumulative sertraline exposure 2
- A statistically significant but clinically minimal increase in standardized weight (standard deviations of 0.02,0.03,0.16, and 0.17 at months 3,6,30, and 36 respectively), observed only at higher sertraline doses 2
- No significant changes in standardized body mass index 2
- Normal cognitive and emotional development across all measures 2
Contradictory Older Evidence
Two older, lower-quality studies suggest potential growth effects, but these have significant methodological limitations:
- A 2002 case series (n=4) reported growth attenuation in children on SSRIs, but this was an uncontrolled case study with no comparison group 3
- A 2018 study found reduced longitudinal growth in risperidone-treated boys taking SSRIs, but this was a sample of convenience in children already receiving antipsychotic medication, making it impossible to isolate SSRI effects from the known metabolic effects of risperidone 4
Critical Distinction: Stimulants vs. SSRIs
Growth suppression is well-documented with stimulant medications (methylphenidate, amphetamines) but not with SSRIs. 1, 5, 6, 7 The American Academy of Pediatrics confirms that stimulants cause approximately 1-2 cm less growth over 2-3 years, with more pronounced effects on weight than height 5. This effect does not translate to clinically meaningful reductions in final adult height 1, 5.
Clinical Monitoring Recommendations
While growth suppression is not an established SSRI adverse effect, routine monitoring remains appropriate:
- Monitor for appetite changes and weight fluctuations as part of standard SSRI adverse effect surveillance 1
- Weight loss or gain can occur as transient early adverse effects but are not associated with sustained growth suppression 1, 8
- Most physical symptoms, including gastrointestinal effects that might affect nutrition, decrease over the first 12 weeks of treatment 8
Common Pitfalls to Avoid
- Do not confuse stimulant-related growth effects with SSRI effects—these are distinct medication classes with different adverse effect profiles 1, 5, 6
- Do not extrapolate from case reports or studies in special populations (e.g., children on antipsychotics) to the general pediatric population 3, 4
- Do not withhold indicated SSRI treatment based on unfounded concerns about growth, as untreated anxiety and depression carry significant morbidity 1