Fluoxetine in Children and Adolescents with Mood Disorders: A Chart Review of Efficacy and Adverse Effects

The charts of 31 hospitalized children and adolescents (ages 9–18 years) with major mood disorders were retrospectively reviewed to examine the efficacy and side effects of treatment with fluoxetine. After treatment for a mean duration of 35 days, clinical improvement was seen in 74% of these patients; 54% had "much" to "very much" improvement as measured by the Clinical Global Impression scale (CGI). The most common adverse effects were hypomania-like symptoms (23%), irritability (19%), gastrointestinal upset (13%), and insomnia (13%). No EKG changes, blood pressure changes, anticholinergic symptoms, sedation, weight changes, or seizures were observed. None of the patients experienced an increase in suicidal or parasuicidal behavior. Discontinuation of the fluoxetine treatment occurred in 28% of cases, most commonly because of increasing irritability and hypomania-like symptoms. The hypomania-like effects included a constant sense of silliness, increased activity, poor sleep, increased energy, an increase in the stream of thoughts (racing thoughts), or socially intrusive or obnoxious behavor. Fluoxetine triggered symptoms suggestive of hypomania in all four of the depressive bipolar patients.