Age Effects on Antidepressant-Induced Manic Conversion

Abstract

Patient age is an effect modifier on the risk of antidepressant-associated manic conversion. Treatment with antidepressants is associated with highest conversion hazards among children aged 10 to 14 years.

Iatrogenic Comorbidity in Childhood and Adolescence: New Insights from the Use of Antidepressant Drugs

“…Furthermore, during treatment with antidepressant drugs, the incidence of manic or hypomanic manifestations was much higher than that in comparable reports involving anxious adults and similar to that found among depressed adults [20]. Martin and colleagues investigated the risk of manic conversion among more than 87,000 mental health users aged between 5 and 29 years [21]. Results showed that overall the prevalence rate of conversion was 5.4 % (N = 4,748).…”

Imipramine-induced mania in a child diagnosed with attention-deficit/hyperactivity disorder (ADHD): a case report

“…Children and adolescents treated with ADs are at higher risk for developing hypomania and mania compared with adults. Martin et al found the rate of mania-hypomania symptoms as 5.4%, in a large young aged population under treatment with an AD [13]. According to a review comparing 29 single case studies and randomized controlled trials (RCTs), it was determined that youth who develop manic symptoms as a result of antidepressant treatment have genetic vulnerabilities and have a family history for bipolar disorder (BD) [14].…”

“…Mood elevation risk may be greater in treatment with tricyclic ADs than with SSRIs [17]. On the other hand, treatment with ADs in the paediatric population has also been associated with "behavioural activation"; a more broadly defined phenomenon by comparison with treatment-induced mania [13]. The term of "behavioural activation" which occurs at higher rates in paediatric patients than adults refers to; hyperactivity, impulsivity, insomnia or disinhibition and, importantly shows a distinct clinical pattern from treatment-emergent mania [22,23].…”

Treatment of Pediatric Bipolar Disorder

“…[27] Ana endişe, eklenen antidepresanın manik kaymaya ya da yeni bir manik atağa yol açmasıdır. [28] Antidepresanlardan venlafaksin ile yüksek oranda manik kayma ve hipomani indüklenmesi bildirilmiş, bupropion ve antidepresan olmamasına rağmen bipolar depresyonda bulgularda düzelme sağlayabilen modafinil ile daha az oranda manik kayma tespit edilmiştir. [29] Ergen çalışmalarında, bazı ergenlerde antidepresanlar ile intihar fikir ya da davranışlarının ortaya çıkabileceği gösterilmiştir.…”

“…Eski veriler 10-14 yaş arası çocuklardaki major depresyonun SSGİ'lerle tedavisi sonrasında bipolar bozukluğa dönüşme oranının yüksek olabileceğine işaret etmekteydi. [28] Ancak daha sonra yapılan birçok çalışmada bu doğrulanamamıştır. [39] Bu durum, bipolar bozukluğu olan çocuk ve ergenlerin antidepresan ilaçlara daha fazla hassasiyetleri olabileceği şeklinde yorumlanabilir.…”