Antidepressant-Induced Apathy in Children

Reinblatt and Riddle (2006) stated, Selective serotonin reuptake inhibitor (SSRI)-induced apathy is characterized by a lack of motivation that is not a result of sedation or symptoms of depression. In a review of 43 participants in a fluvoxamine pediatric research project, the authors identified two (5%) cases of apathy, one in a 9-year-old and the other in a 16-year-old, neither of whom was depressed. They found that similarities to existing reports included Lack of insight, delayed onset, dose dependency, and reversibility with SSRI dose reduction or discontinuation.  

Reinblatt and Riddle (2006) concluded, SSRI-induced amotivational syndrome is a more important and frequent clinical issue than suggested by the paucity of published reports. It may go undetected in its milder forms owing to delayed onset and variable severity of presentation.  

Garland and Baerg (2001) described cases of apathy, one accompanied by disinhibition, in a child and four adolescents. A 14-year-old boy on paroxetine became so flat that his face became masklike, similar to parkinsonism, but without any other signs of that disorder. His parents and the clinician were concerned about his loss of interest, but typical of severe medication spellbinding, the patient was quite satisfied with his life and did not recognize a problem.  

A 14-year old boy taking fluoxetine again demonstrated medication spellbinding (Garland et al., 2001)  

In a follow up visit 6 weeks after the dose increase, his affect was flat, and he appeared emotionally disconnected and apathetic. However, he reported that he felt fine and was not in any way unhappy or distressed about his situation despite a large drop in his grades. 

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