Behavioral changes as side effects due to anti-depressant

[fairweather]

My 15 year old daughter was prescribed Paxil about 4 months ago to treat mild depression.  I have noticed many side effects, which are acknowledged by the drug company.  But I have noticed changes in her behavior that are not listed as "side effects" and am wondering if these have been reported. Aside from reading one article, in which the teenager girl taking an SSRI for headaches, became a "wild" teenager, which was a departure from her normal behavior, I have not heard of any "behaviorial" side effects, like I am about to describe.  I have noticed recently that my daughter is not always truthful with us.  You may say this is normal teenage behavior, but to my knowledge she has been truthful in the past.  Also, she does not seem as compassionate or remorseful as she used to be.  But my biggest concern is that she seems to be becoming less inhibited in her behavior and taking bigger risks for excitement.  One example is telling us she was spending the night at a girlfriends house and then not going there, but instead staying at her boyfriends house.  Another example is giving her permission go to the mall, but then we found out afterwards that she went to a "punk rock show".  I am just wondering if the Paxil is numbing her to the extent that she feels the need to take bigger risks to feel happy or excited.  Also, she used to be very emotional when watching movies, crying at the sad parts, or when reading a book, and I have not seen her cry in a long time.  She also seems to not care about her schoolwork like she used to. She is taking Paxil CR 12.5 mg po tab.  Any insight would be appreciated.  She originally was prescribed lexapro, but could not tolerate it due to severe headaches.  She is also in therapy for the depression/anxiety which was mostly related to school.  She was out of school this last semester doing "homebound" schooling, but her motivation for school work in general is waning.  She has been an A/B student in Advanced Placement Classes, marching band, soccer.  I'm worried.  Also she seems to be changing her cirlce of friends which now include a couple of high school dropouts, and generally kids that do not have the best judgment when it comes to making intelligent choices about their behavior.  Thank you.

[Kevin Kennedy, Ph.D.]

Much of what you describe cannot really be atributed to the Paxil, but rather appear to be symptoms which result from the intersection of adolescence with her emotional condition. One of the side effects of the SSRI's can be a sort of activation or agitation, and if you see that it is worth considering it might be related to the medication. The risk-taking behavior, typical of may adolescents, may not be related to the medication, unless the risk-taking involves reckless, disinhibited, very impulsive behavior. It might also be worth having a random toxic screen (urine screen is better than blood screen) done to investigate the presence of any illicit substances. With the change in her peer group, it might be that she is engaging in some substance use which has not been identified. Finally, I assume you've spoken with her prescribing doctor about FDA cautions re: use of SSRI's other than Prozac in the treatment of depressive disorders in adolescents. Many of us believe that use of many of the SSRI's is quite safe, provided adequate monitoring is occurring, and that it is overkill to abandon use of all the SSRI's except Prozac. Nonetheless, the matter should be discussed so that you can make an informed decision.