Behavioral Side Effects of Fluoxetine in Children and Adolescents

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Abstract
Twelve (50%) of 24 children, ages 8 to 16 years, treated with fluoxetine, 20 or 40 mg/day, for depressive or obsessive compulsive symptoms, developed behavioral side effects characterized by motor restlessness (n = 11), sleep disturbance (n = 11), social disinhibition (n = 6), or a subjective sensation of excitation (n = 3). No major changes in the neurological status of these children were observed. However, the three children with ADHD showed an exacerbation of symptoms on fluoxetine. Discontinuation (n = 5) or halving the dosage (n = 7) resulted in complete resolution of these unwanted symptoms within 1 to 2 weeks. In all 7 children whose doses were reduced, improvement of the depressive or obsessive compulsive symptoms was maintained on the lower dosage. Clinicians treating children with fluoxetine are cautioned to be aware of behavioral side effects which may be alleviated by dosage reduction or possibly by starting with lower doses. These side effects may be difficult to differentiate from common psychopathological symptoms such as hyperactivity, restlessness, and impulsivity.

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