Using a large electronic health record database to characterize ssri's effect on height growth

The University of Houston System received a $846,528 Project Grant from the National Institute of Child Health and Human Development (NICHD) under the Child Health and Human Development Extramural Research program (CFDA 93.865), awarded September 5, 2025, with completion targeted for August 31, 2027. This research project utilizes a large electronic health record database spanning 12 years to characterize the effects of selective serotonin reuptake inhibitors (SSRIs) on height growth in adolescents. The study employs advanced Super-Imposition by Translation and Rotation (SITAR) growth curve analyses to determine the impact of SSRIs on height growth, evaluate how the magnitude and timing of SSRI exposure moderate growth suppression effects, and identify differences among commonly prescribed SSRIs. The research will examine whether discontinuing SSRIs normalizes growth trajectories and whether any effects on height persist into adulthood.

Baylor College of Medicine serves as a sub-awardee on this project, with Dr. Chadi Calarge functioning as Co-Investigator alongside Co-PI Chen and Ms. Stephanie Dinh contributing as research personnel. The sub-awardee team is responsible for implementing core research activities including weekly team coordination meetings, overseeing data cleaning and integrity verification, guiding statistical analyses, and supporting result interpretation. This collaborative research addresses a significant clinical question regarding the long-term developmental effects of widely prescribed antidepressants in the adolescent population.

Abstract

The pubertal growth spurt is a hallmark of adolescence, which is a time of increasing vulnerability to depressive and anxiety disorders, a fact reflected in the widespread use of antidepressants, particularly selective serotonin reuptake inhibitors (ssris). In fact, antidepressants comprise the second to third most prescribed medication class in this age group. We and others have found that ssris are associated with height growth suppression in adolescents. This was particularly true in boys undergoing puberty. To build on these findings, we recently completed another study (R21HD097776) of children and adolescents undergoing puberty and starting treatment with one of two commonly prescribed ssris, sertraline, and fluoxetine. We again found that, over the 6-month follow-up period, the higher the ssri dose, the more significant height growth suppression was. In fact, ssri use reduced growth by about 50% of that observed in unmedicated participants. Notably, sertraline was associated with the most significant deleterious effect on height. Moreover, the higher the ssri dose, the lower the serum concentration level of insulin growth factor 1), the principal marker of growth hormone neurosecretory function. To better capture the implications of these findings at a large scale, we here propose to use 12 years of data from a very large electronic health record database and state-of-the-art super-imposition by translation and rotation (sitar) growth curve analyses to determine 1) the effect of ssris on height growth, 2) the moderating role of the magnitude of ssri exposure and its timing in relation to the growth spurt on height growth suppression, and 3) whether differences between the most prescribed ssris exist. This work will allow US to determine whether ssri discontinuation normalizes height growth, leaving adult height unaffected. In SUM, the proposed study will be the first to investigate the magnitude of height growth suppression induced by ssris, its clinical predictors, and its long-term sequelae, shedding light on a currently little-recognized side effect of a widely and increasingly used medication class. The information will be critical to inform clinical decision making.