SSRI Antidepressants in Youth-Amotivational Syndrome

This article discusses recent findings on SSRI  meds Fluoxtine and Paroxetine (Paxil) potentially causing reversible frontal lobe syndrome in adolescents.  This is reported as a "rare" side effect.

Frontal lobe syndrome makes the patient apathetic, lose  initiative, ie indifferent. (Note: this report suggests some adults develop this syndrome too with these drugs)

Parents of any adolescents on either of these 2 drugs who have been experiencing problems with apathy, attitudes of indifference, loss of initiative, etc. that they had not been experiencing before taking the drug may want to consult with their neurologists.  This would apply to any adults who have experienced this too.

An Unprofessional Opinion
Love
Jean
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October 20, 2001
The Brown University Child and Adolescent Psychopharmacology Update
Amotivational Syndrome Linked With SSRI Use in Youth for the First Time
[Brown Univ Child and Adol Psychopharm 3(10):1,
6-8, 2001 by Manisses Communications Group, Inc.]

E. Jane Garland, M.D., clinical associate professor of psychiatry and Elizabeth A. Baerg, M.D., clinical assistant professor of psychiatry at the University of British Columbia's Children's Hospital in Vancouver, Canada,

report on five patients with dose-dependent, reversible frontal
lobe (amotivational) syndrome characterized by delayed onset after treatment with fluoxetineand paroxetine, two selective serotonin reuptake inhibitors (SSRIs) commonly prescribed to treat adolescent depression.

A frontal lobe syndrome characterized by apathy, indifference, loss of initiative and/or disinhibition has developed in some adults during SSRI therapy but has not been previously reported in the pediatric population (Hoehn-Saric et al. 1990). In each case the patient had a significant change in behavior, which included becoming indifferent toward work performance, exhibiting impulsive and disinhibited behavior, or developing poor concentration and forgetful behavior (Hoehn-Saric et al. 1991).

Although a frontal lobe syndrome may be rare, it is important to consider, as its symptoms could be easily misinterpreted. Apathy and indifference could be mistakenly attributed to depressive symptoms or sedation; impaired judgment and disinhibition could be attributed to hypomania -induced behavior.

According to Garland, delayed onset is a consistent feature in both adult and child cases, although there is presently little understanding behind the late onset of symptoms.

"One hypothesis is that it only becomes evident as the primary condition remits and function returns. However, the common pattern is a period of 3-4 weeks or a month of good functioning before it is evident. Another hypothesis is that there is some neurochemical adaptation occurring, perhaps involving the dopaminergic system, or even the complex network of serotonin receptor subtypes," says Garland.

(see website for cases)

Conclusions
"Clearly, it is important to weigh the risks and benefits [of treatment with SSRIs] carefully with children and families," Garland says. "A good measure is overall function in various dimensions of life. A young person who is apathetic may be easier to parent in some ways, but the negative effects on academic and social functioning with peers needs to be considered. This takes ongoing monitoring and negotiation, and input of various observers, including teachers."

Garland concludes, "These case reports remind us that intermediate term side effects, such as the more common sexual side effects and less common amotivational syndrome, require awareness on the part of the treating physician, and specific inquiry as patients may not bring them up spontaneously."

"These case reports also draw attention to the complex neurochemical effects of medications which overall have a relatively benign profile of side-effects.what this means for longer-term use, over several years, is less clear. While these medications clearly improve symptoms and quality of life
tremendously, we need to keep an open mind and clinical awareness for new patterns of unexpected effects."

References - See resource website
Resource:  Medscape
http://www.medscape.com/Manisses/CPU/2001/v03.n10/cpu0310.01/cpu0310.01.html

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Fluxotine - the Mental Health Medication site says safety and effectiveness in patients below the age of 18 have not been established for this drug.  It also warns about neurologic side affects, many which mimic HD symptoms
http://www.mentalhealth.com/drug/p30-p05.html

Paroxetin (Paxil)- Again the safety and effectiveness of paroxetine in children under 18 years of age have not been established. This one appears to have a lower incidence of neurological symptoms based on tests however the "rare" incidences of the nervous system cover antisocial behavoir, abnormal gait, dystonia, etc.
http://www.mentalhealth.com/drug/p30-p02.html

Both report a common side affect is somnolence/drowsiness.  All drugs, as well as the condition for which they are prescribed,  for 54 common disorders such as depression, bi-polar can be found at http://www.mentalhealth.com/