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Activation in Children and Adolescents Treated With Selective Serotonin Reuptake Inhibitors

A Weighty Reason?

Garcia-Delgar, Blanca MD*; Morer, Astrid MD, PhD*†‡§; Varela, Eva MD*; Romero, Soledad MD, PhD*†; García, Marta MD*; Coffey, Barbara J. MD, MS∥¶; Lázaro, Luisa MD, PhD*†‡§

Journal of Clinical Psychopharmacology: October 2018 - Volume 38 - Issue 5 - p 475–480
doi: 10.1097/JCP.0000000000000923
Original Contributions

Background Activation is a behavioral adverse event related to the use of psychotropic medication. Its high incidence in pediatrics and in childhood-onset neuropsychiatric disorders suggests it may be linked to neurodevelopment. However, previous studies have scarcely examined the role that factors relevant to developmental pharmacokinetics, such as body weight, may play in the onset of activation in children and adolescents.

Methods We conducted a retrospective analysis of hospitalized patients to identify the risk factors for activation in children and adolescents treated with selective serotonin reuptake inhibitors. Our focus was on factors related to development, including body weight, to explore the relationship between activation and neurodevelopmental processes.

Results Among the 139 participants (mean age, 14 ± 2.3 years), activation appeared in 29 (20.9%). Age 12 years or younger and comorbid diagnosis of autism spectrum disorder were associated with statistically significant increases in the risk of activation, but no association was found regarding body weight.

Conclusions Our findings support the hypothesis that activation is closely linked to brain development processes. Longitudinal studies are needed to explore this line of research further.

From the *Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic Universitari, Barcelona,

Centro de Investigación en Red de Salud Mental, Instituto Carlos III, Madrid,

Institut d'Investigacions Biomèdiques August Pi i Sunyer,

§Department of Medicine, University of Barcelona, Barcelona, Spain;

Department of Child and Adolescent Psychiatry, University of Miami Miller School of Medicine, Miami, FL; and

Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY.

Received December 12, 2017; accepted after revision May 11, 2018.

Reprints: Luisa Lázaro, MD, PhD, Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic Universitari, c/ Villarroel 170, Section 9 Floor 2, 08036 Barcelona, Spain (e-mail:

Barbara J. Coffey and Luisa Lázaro share the senior authorship.

Supported by the “Agència de Gestió d’Ajuts Universitaris i Recerca” of the Generalitat de Catalunya to the Child Psychiatry and Psychology Group (2014 SGR 489).

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