Fluoxetine and sertraline inhibit height growth and growth hormone signaling during puberty

Authors: CALARGE, CHADI - Baylor College Of Medicine; AMUSHIE, CHIMA - University Of Texas Health Science Center; DINH, STEPHANIE - Baylor College Of Medicine; MILLS, JAMES - University Of Iowa; DEVARAJ, SRIDEVI - Baylor College Of Medicine; BARBA-VILLALOBOS, GRISELDA - Baylor College Of Medicine; NGUYEN, JACQUELINE - Baylor College Of Medicine; GARCIA, JOSE - University Of Washington; SISLEY, STEPHANIE - Baylor College Of Medicine; BACHA, FIDA - Children'S Nutrition Research Center (CNRC); BABETTE, ZEMEL - University Of Pennsylvania

Submitted to: Journal of Clinical Psychopharmocology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 7/22/2024
Publication Date: 11/1/2024
Citation: Calarge, C., Amushie, C., Dinh, S., Mills, J., Devaraj, S., Barba-Villalobos, G., Nguyen, J., Garcia, J., Sisley, S., Bacha, F., Babette, Z. 2024. Fluoxetine and sertraline inhibit height growth and growth hormone signaling during puberty. Journal of Clinical Psychopharmocology. 44(6):538-544. https://doi.org/10.1097/JCP.0000000000001922.
DOI: https://doi.org/10.1097/JCP.0000000000001922

Interpretive Summary: Two antidepressants, fluoxetine (Prozac) and sertraline (Zoloft), are commonly prescribed to treat anxiety and depression in children and adolescents. However, their impact on growth during puberty, is unclear. This study aimed to explore whether these medications affect height growth and related hormones in 8 to 15 year old children over a 6-month duration. Researchers found that kids taking these medications grew less in height compared to those who weren’t on them. The effect seemed to depend on the dose—the higher the dose, the more growth was slowed down. Additionally, the study found that these medications lower levels of a growth-related hormone called IGF-1, which plays a role in helping kids grow taller. The body mass index (BMI) of kids on sertraline also increased more than those on fluoxetine. While these results suggest that these medications might impact growth during puberty, longer studies are needed to see the full effects over time.

Technical Abstract: The aim of this study was to examine the effect of fluoxetine and sertraline on height growth and insulin-like growth factor-1 (IGF-1) during puberty. In this 6-month cohort study, electronic medical records were used to identify 8- to 15-year-old participants, within 1 month of starting fluoxetine (n = 39) or sertraline (n = 27), and sexual maturation stages 2 to 4 were confirmed. Conditions that interfere with height growth led to exclusion. Participants underwent anthropometric assessments and phlebotomy. Healthy, unmedicated children (n = 36) also provided anthropometric data. After the baseline height Z-score, sex, Tanner stage, daily selective serotonin reuptake inhibitor (SSRI) dose, and time were accounted for, the interaction effect of dose by time was inversely associated with height Z-score in SSRI-treated participants (B = -0.18; 95% confidence interval [CI]: -0.35, -0.02). Sertraline and fluoxetine did not differ in their effect on height growth. Compared with being unmedicated, SSRI treatment was associated with a smaller growth in height (time × dose 2-way interaction effect B = -1.30; 95% CI: -2.52, -0.09). The interaction effect of dose by time was significant for body mass index Z-score (B = 0.35; 95% CI: 0.06, 0.64) but not weight Z-score (B = 0.24; 95% CI: -0.01, 0.49). Body mass index Z-score increased more with sertraline compared with fluoxetine (time × dose × SSRI type 3-way interaction effect P < 0.05). SSRI dose was inversely associated with IGF-1 (B = -63.5; 95% CI: -112.2, -14.7) but not insulin growth factor binding protein-3 concentration (B = -207.3; 95% CI: -536.2, 121.5). Fluoxetine and sertraline reduce height gain and IGF-1 concentration, in a dose-dependent manner. Longer-term studies are necessary.