# Treatment of Depression in Adolescents With Myasthenia Gravis

## TL;DR

This case report describes a teenager with myasthenia gravis and depression who improved on fluoxetine without worsening muscle symptoms.

## Contribution

Demonstrates that SSRIs like fluoxetine may be safe for treating depression in adolescents with MG, challenging prior concerns.

## Key findings

- Fluoxetine improved depressive symptoms without worsening MG in a pediatric patient.
- MG symptoms remained stable during SSRI treatment despite theoretical concerns about acetylcholine receptor interactions.
- The case suggests SSRIs could be viable for depression in MG patients, requiring further study.

## Abstract

Myasthenia gravis (MG) is an autoimmune disorder in which, most commonly, there is a production of autoantibodies against the nicotinic acetylcholinergic receptors at the neuromuscular junction, resulting in skeletal muscle weakness. For pediatric patients, literature addressing the psychiatric implications of MG and suitable treatment options for individuals with concurrent psychiatric illnesses is scarce. In this case report, an adolescent with MG and comorbid depression was treated following a suicide attempt via self-poisoning. The patient experienced an improvement of depressive symptoms upon initiating fluoxetine, despite concerns raised by previous studies suggesting that fluoxetine might block acetylcholine receptors at the neuromuscular junction with varying degrees of affinity, potentially worsening MG symptoms. In this case, our patient exhibited sustained control of her MG symptoms without exacerbation once she was started on fluoxetine. This case highlights the value of further investigation into the safety and efficacy of selective serotonin reuptake inhibitors (SSRIs) in the management of depression among pediatric patients with MG.