Answers About Antidepressant-Induced Mania in Youth Remain Elusive

Depression is a common first sign of bipolar disorder, especially in children. It appears that the younger the onset of depression, the greater the risk of bipolar illness. But treating the depression can lead to antidepressant-induced mania (AIM) in children, and little is known about why that happens and which children are vulnerable. "We don't know whether these antidepressants trigger bipolar disease in vulnerable children or how best to treat them," said Kiki Chang, M.D., who chaired a symposium at the annual meeting of the American Academy of Child and Adolescent Psychiatry. Chang is a professor at Stanford University School of Medicine and director of the Pediatric Bipolar Disorders Program at Lucile Packard Children's Hospital.

Chang described how rates of AIM appear higher in such specialty clinics than is recognized in the literature. There is no clear evidence that antidepressants accelerate the natural course of bipolar disorder development in overall samples, but Chang recommends that in individual cases prescribers proceed cautiously when using these drugs in youth already at risk for developing bipolar disorder, such as those with ADHD and mood dysregulation, a history of AIM or psychosis, or a family history of bipolar disorder.

A recent study shows that the prevalence of bipolar disorder in youth is similar to that in adults. Read more in Psychiatric News here. Read more about bipolar disorder in the Handbook of Diagnosis and Treatment of Bipolar Disorders from American Psychiatric Publishing.

(Image: Stanford University)