Bipolar disorder children at risk of antidepressant-induced mania


21 November 2006

Children and adolescents with or at high risk of bipolar disorder appear to be particularly susceptible to antidepressant-induced mania with selective serotonin reuptake inhibitor (SSRI) treatment, research shows.

In their study of 52 children and adolescents with an average age of 15 years who had bipolar disorder or subthreshold manic symptoms, investigators from Stanford University School of Medicine in California, USA, found that half tested positive for antidepressant-induced mania.

"The high rate of antidepressant-induced mania in our sample has important implications for the management of children and adolescents with bipolar disorder or subsyndromal bipolar disorder," note Fiona Baumer and colleagues.

"Clinicians might first consider alternate agents to treat symptoms of depression and/or anxiety in this population."

The researchers carried out interviews with the participants' parents to gather information on manic and depressive symptoms occurring in the children before and after past antidepressant treatment. In addition, 47 of the children exposed to SSRI treatment were genotyped for the serotonin transporter (5-HTT) gene, variations of which have previously been linked to antidepressant drug responses.

In all, 50% of the children tested positive for antidepressant-induced mania, with 38.5% experiencing a new manic episode and 11.5% experiencing worsening of a pre-existing episode.

In addition, for the 47 participants for whom information on suicide was available, 25.5% had onset of suicidal ideation within the first 3 months of taking antidepressants.

The researchers note in the journal Biological Psychiatry that children with bipolar I disorder were more likely to suffer antidepressant-induced mania than those with bipolar II disorder or subsyndromal symptoms, at rates of 61.5% versus 7.7% and 30.8%, respectively.

They suggest that antidepressant-induced mania may be related to the severity of bipolar disorder, on finding that children with the condition tended to have more comorbid Axis I diagnoses than those without antidepressant-induced mania.

In contrast, there was no association between the different 5-HTT genotypes and antidepressant-induced mania, but Baumer and team suggest that this negative finding may be due to the small sample size.

Given their findings, Baumer et al recommend: "All children, particularly those with bipolar disorder, should be carefully assessed after beginning antidepressant treatment for emergence of mania and/or suicidal symptoms, and these symptoms should be carefully differentiated from uncomplicated behavioral activation."



Source: Biol Psychiatry 2006; 60: 1005–1012