Re: “Effects of Long-Term Sertraline Use on Pediatric Growth and Development: The Sertraline Pediatric Registry for The Evaluation of Safety (SPRITES)” by Kolitsopoulos et al.

To the Editor:

I read, with great interest, the article by Kolitsopoulos et al. reporting on the effects of sertraline on growth and development in children and adolescents (Kolitsopoulos et al., 2023). This important study is necessary to ensure the long-term safety of such medications, consistent with the spirit of the commitment made by the manufacturer to the European Medicines Evaluation Board (Kolitsopoulos et al., 2023).

Given that height assessment may be quite vulnerable to measurement error (Mikula et al., 2016), thus influencing the findings, it would be useful to describe the method used to capture height and its reliability in this sample.

The authors used two complementary self-rating approaches to capture stage of sexual maturation, finding that 198 (49.1%) of boys and 212 (39.4%) of girls were in stage I or V at study entry (based on Table S5) (Kolitsopoulos et al., 2023). My colleagues and I have found that the deleterious effect of selective serotonin reuptake inhibitors (SSRIs) on height in boys was most pronounced in sexual maturation stages 3 and 4, a time when height velocity peaks (Calarge et al., 2018). Although the participants in that study were cotreated with risperidone, we have now replicated this finding in children on SSRI monotherapy (article in preparation). Given that a substantial number of the participants in the Sertraline Pediatric Registry for The Evaluation of Safety (SPRITES) study were in stage I or V, it may be informative to evaluate whether the findings reported by Kolitsopoulos et al. would vary based on stage of sexual maturation.