Antidepressant exposure in bipolar children

Psychiatry. 2003 Winter;66(4):317-22. doi: 10.1521/psyc.66.4.317.25437.

Abstract

BIPOLAR disorder is increasingly diagnosed in children and adolescents. Given that antidepressants may precipitate mania, and with increased use of antidepressants in youths, it is reasonable to ask whether antidepressant administration might play a role in inducing earlier manic episodes. We reviewed all consecutive admissions with a diagnosis of bipolar disorder to a university-affiliated children's hospital, and collected information regarding previous exposure to antidepressants and stimulants. The mean age of diagnosis of bipolar disorder in our cohort was 12 +/- SD 3.47 years. Children who received prior antidepressant and/or stimulant treatments had an earlier bipolar diagnosis (10.7 +/- 3.05 years) than children never exposed to these medications (12.7 +/- 4.3 years; one-tailed t = -1.33, df = 22, p = .099, power = .93). Stimulants appeared to be tolerated for a longer duration than antidepressants (55.5 +/- 20.42 months vs. 6.7 +/- 8.22 months, t = 6.6, df =12, p = .0001). Despite methodological imperfections, results indicate that children exposed to antidepressants appear to be diagnosed with bipolar disorder earlier than those never exposed to these medications. Although far from conclusive, these data are consistent with the hypothesis that antidepressant treatment is associated with a manic episode earlier than might occur spontaneously.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Age Factors
  • Antidepressive Agents / adverse effects*
  • Antidepressive Agents / therapeutic use
  • Bipolar Disorder / chemically induced*
  • Bipolar Disorder / diagnosis
  • Bipolar Disorder / epidemiology
  • Central Nervous System Stimulants / adverse effects
  • Central Nervous System Stimulants / therapeutic use
  • Child
  • Comorbidity
  • Cross-Sectional Studies
  • Data Collection / statistics & numerical data
  • Female
  • Hospitals, Pediatric / statistics & numerical data
  • Hospitals, University / statistics & numerical data
  • Humans
  • Male
  • Mental Disorders / diagnosis
  • Mental Disorders / drug therapy
  • Mental Disorders / epidemiology
  • Psychotropic Drugs / adverse effects
  • Psychotropic Drugs / therapeutic use
  • Retrospective Studies
  • Risk Factors

Substances

  • Antidepressive Agents
  • Central Nervous System Stimulants
  • Psychotropic Drugs