Starting a 13YO on Sertraline (Zoloft) vs Fluoxetine (Prozac)
We’re considering starting our soon to be 13 yo on medication and wanted to get input from other parents who’ve tried
…fluoxetine (Prozac) or
…sertraline (Zoloft)
for their child. It’s mainly for OCD, but our preteen also has general anxiety, probably social anxiety, ADHD-combined (… ASD1 isn’t ruled out - even after a recent neuropsych eval).
We know one size doesn’t fit all, but we are wondering how these two meds compare. Does one have more side effects than the other? If both parents haven’t had side effects, does that mean the child will tolerate the medication better? We would really appreciate any other insight/useful info to consider as we consider this big step. Thank-you!
May 18, 2023
Parent Replies
Hi,
I'm a retired primary care doc. Yes there are important differences. Prozac (fluoxitine) tends to be more energizing while sertraline is more calming. I don't have statistics but there were reports of teen suicides with Prozac many years ago. They may not have proved statistically significant. You can probably find out about that by Googling Prozac and teen suicide. In terms of adults, sertraline tends to have greater positive results for depression, but as you say, it has to be individualized. As far as OCD, my own choice is, as much as it may dismay you, marijuana. You can Google Dr. Mike Alcalay (now deceased) who was the expert in the field of medical marijuana and for OCD. Under his name you may (hopefully) find a segment on 60 minutes with Mike where a very young child with OCD was so unmanageable that he could not be kept in school. On marijuana that his mom cooked into brownies every day he became almost instantly calmed and returned to school and was integrated well when the report was done (maybe 20 years ago). I don't know how much weight the poor child put on and I don't have any follow up into his teen years. He took a high dose. My choice of anti-depressants in elders has long been sertraline. Taken before bed it can also help them sleep. Medicating a 13 old with psychoactive drugs requires close monitoring (hopefully by a counselor).
Marc Sapir MD, MPH
I cannot speak to comparing the 2 medications but here is how to avoid any side effects with either med. Instead of starting say at a dose of 10mg of Fluoxetine, ask the Pharmacist for tablets in stead of capsules. Then you can cut them into quarters. Start off at 2.5mg for 2 weeks, then every 2 weeks increase by 2.5 mg. This will do 2 things: 1) There will be zero side effects with this gradual build up, and 2) it will help you titrate exactly how much medication is needed so your child will not take more than is needed to control their symptoms. You will know when an adequate dose is reached and it may be 7.5mg rather than 10mg, or 12.5 rather than 20mg for example.
Hi! I would recommend treating the ADHD first- once this is treated other things fall into place. I have lifelong experience with this. The longer the ADHD is treated, you have positive experiences to build self esteem. When the adhd treatment (medication) isn’t there it’s like riding a bike without glasses.
Hello! I’m so glad you are considering medication treatment for your child! I’m a family med doc who prescribes SSRIs for a range of ages and conditions. Also, my son took Zoloft for 3 years for depression and I have friends whose dtr has responded really excellently to Zoloft for OCD
Everyone responds differently to different SSRIs but the 2 main differences are that Prozac is more energizing (which can be a pro or a con) and also Prozac has a longer half life so if your child is likely to miss doses (due to all kinds of individual and family-related factors) then the effect of the Prozac will be steady even in the face of erratic dosing.
good luck to you and your family