Treatment-emergent mania in pediatric bipolar disorder: a retrospective case review

Faedda, Gianni L.; Baldessarini, Ross J.; Glovinsky, Ira; Austin, Nancy B.

doi:10.1016/j.jad.2003.12.011

Cited by 93 publications

(61 citation statements)

References 37 publications

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“…1). They included 17 studies regarding AD trials in juvenile depressive disorders, with or without other psychiatric disorders (n = 2,637 subjects, 2,083 given an AD and 554 controls), 16 of which provided quantitative estimates of behavior outcomes considered as adverse events (see online supplementary table 1; for all online supplementary material, see www.karger.com?doi=10.1159/000345316) [34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50]; 25 studies involved AD trials in juvenile anxiety disorders, with or without other psychiatric disorders (n = 4,130 subjects, 3,211 given an AD and 919 controls; online suppl. table 2) [51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76].…”

Section: Resultsmentioning

confidence: 99%

“…table 1). Three studies included currently depressed juveniles who were suspected of having BPD but did not include a control condition to indicate risk of spontaneous behavioral changes [40,44,46]. The range of responses considered precludes confident estimates of occurrence rates, which ranged from 0.3% for reactions considered to represent hypomania in a recent, large, prospective treatment trial involving treatment-resistant depressed, mainly adolescent, patients [50] to 50% for ‘manic symptoms' in a small retrospective study [46].…”

Section: Resultsmentioning

confidence: 99%

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Excessive Mood Elevation and Behavioral Activation with Antidepressant Treatment of Juvenile Depressive and Anxiety Disorders: A Systematic Review

Offidani

Fava

Tomba

et al. 2013

Psychother Psychosom

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Background: The prevalence, characteristics and implications of excessive arousal-activation in children and adolescents treated with antidepressants for specific illnesses have not been systematically examined. Methods: We compared reports of antidepressant trials (n = 6,767 subjects) in juvenile depressive (n = 17) and anxiety disorders (n = 25) for consensus-based indications of psychopathological mood elevation or behavioral activation. Results: Rates of excessive arousal-activation during treatment with antidepressants were at least as high in juvenile anxiety (13.8%) as depressive (9.79%) disorders, and much lower with placebos (5.22 vs. 1.10%, respectively; both p < 0.0001). The antidepressant/placebo risk ratio for such reactions in paired comparisons was 3.50 (12.9/3.69%), and the meta-analytically pooled rate ratio was 1.7 (95% confidence interval: 1.2-2.2; both p ≤ 0.001). Overall rates for ‘mania or hypomania', specifically, were 8.19% with and 0.17% without antidepressant treatment, with large drug/placebo risk ratios among depressive (10.4/0.45%) and anxiety (1.98/0.00%) disorder patients. Conclusions: Risks of excessive mood elevation during antidepressant treatment, including mania-hypomania, were much greater than with placebo, and similar in juvenile anxiety and depressive disorders. Excessive arousal-activation in children or adolescents treated with antidepressants for anxiety as well as depressive disorders calls for particular caution and monitoring for potential risk of future bipolar disorder.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Excessive Mood Elevation and Behavioral Activation with Antidepressant Treatment of Juvenile Depressive and Anxiety Disorders: A Systematic Review

Offidani

Fava

Tomba

et al. 2013

Psychother Psychosom

Self Cite

View full text Add to dashboard Cite

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“…Previous studies have also demonstrated that anxiety disorders among youth are significant predictors of later BD in adulthood (Goodwin and Hamilton, 2002;Johnson et al, 2000;Kessler et al, 1997;Kim-Cohen et al, 2003;Perugi et al, 2001), and anxiety disorders predate BD among most youth with comorbid anxiety disorders and BD (Dickstein et al, 2005;Dilsaver and White, 1986;Masi et al, 2001;Wagner, 2006). This is important because antidepressants are first-line pharmacotherapy for child and adolescent anxiety disorders (Varley and Smith, 2003;Bernstein and Shaw, 1997) and such treatment risks unmasking latent BD among youth with underlying diathesis (Faedda et al, 2004;Go et al, 1998). Therefore it is of utmost clinical and public health relevance to begin to identify risk factors for BD among youth with anxiety disorders.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and correlates of bipolar I disorder among adults with primary youth‐onset anxiety disorders

Goldstein

Levitt

2007

Journal of Affective Disorders

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Objectives-It is of potentially great public health importance to determine whether youth-onset anxiety disorders are associated with increased prevalence of subsequent bipolar I disorder (BD) among adults, and to identify risk factors for BD in this population. Methods-The 2001-2002National Epidemiologic Survey on Alcohol and Related Conditions was used to identify respondents with social phobia, panic disorder, or generalized anxiety disorder that onset in youth (<19 years) and was not preceded by a major depressive, manic, or mixed episode (N=1,571; 572 males, 999 females). The prevalence of BD among subjects with, versus without, these youth-onset anxiety disorders was examined. Variables that could be associated with increased risk of BD among subjects with youth-onset anxiety disorders were examined, including conduct disorder, youth-onset substance use disorders (SUD), and family history of depression and/or alcoholism. Analyses were computed separately for males and females.Results-The prevalence of BD was significantly greater among adults with, versus without, primary youth-onset anxiety disorders for both males (15.9% vs 2.7%; χ2=318.4, df=1, p<0.001) and females (13.8% vs 2.9%; χ2=346.2, df=1, p<0.001). Youth-onset anxiety disorders remained significantly associated with BD after controlling for interceding major depression, and this was true for each of the specific anxiety disorders examined. Among males with youth-onset primary anxiety disorders, conduct disorder and loaded family history of depression were associated with significantly increased risk of BD. Among females, conduct disorder and loaded family history of alcoholism were associated with significantly increased risk of BD.Conclusions-The prevalence of BD was elevated among subjects with youth-onset primary anxiety disorders, particularly if comorbid conduct disorder was present. Future studies are needed to confirm these findings prospectively, and to develop preventive strategies for populations at risk.

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“…Several retrospective analyses have found a connection between stimulant exposure and the course of BP (Delbello et al 2001;Faedda et al 2004;Reichart 2004), whereas others have not (Biederman et al 1999;Carlson et al 2000;Carlson and Mick 2003). Any retrospective observations linking stimulants and BP must control for the confounding effects of ADHD symptom severity because most children with prepubertal BP first exhibit prominent ADHD symptoms, leading to stimulant treatment at an early age.…”

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confidence: 99%

The Efficacy and Tolerability of Methylphenidate and Behavior Modification in Children with Attention-Deficit/Hyperactivity Disorder and Severe Mood Dysregulation

Waxmonsky

Pelham

Gnagy

et al. 2008

Journal of Child and Adolescent Psychopharmacology

125

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Objectives: This study examines the tolerability and efficacy of methylphenidate (MPH) and behavior modification therapy (BMOD) in children with attention-deficity/hyperactivity disorder (ADHD) and severe mood dysregulation (SMD). Methods: Children (ages 5-12) from a summer program for ADHD were screened for SMD and additional manic-like symptoms using structured assessments and direct clinical interview with the Young Mania Rating Scale (YMRS). The SMD group was comprised of 33 subjects with SMD and elevated YMRS scores (mean ϭ 23.7). They underwent weekly mood assessments plus the daily ADHD measures that are part of the program. The comparison group (n ϭ 68) was comprised of the rest of the program participants. Using a crossover design, all subjects in both groups were treated with three varying intensities of BMOD (no, low, high) each lasting 3 weeks, with MPH dose (placebo, 0.15 mg/kg t.i.d., 0.3mg/kg t.i.d., and 0.6mg/kg t.i.d.) varying daily within each behavioral treatment. Results: Groups had comparable ADHD symptoms at baseline, with the SMD group manifesting more oppositional defiant disorder/conduct disorder (ODD/CD) symptoms (p Ͻ 0.001). Both groups showed robust improvement in externalizing symptoms (p Ͻ 0.001). There was no evidence of differential treatment efficacy or tolerability. Treatment produced a 34% reduction in YMRS ratings in SMD subjects (p -0.001). However, they still exhibited elevated YMRS ratings, more ODD/CD symptoms (p Ͻ 0.001), and were more likely to remain significantly impaired at home than non-SMD subjects (p Ͻ 0.05). Conclusions: MPH and BMOD are tolerable and effective treatments for children with ADHD and SMD, but additional treatments may be needed to optimize their functioning. 573

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Treatment-emergent mania in pediatric bipolar disorder: a retrospective case review

Cited by 93 publications

References 37 publications

Excessive Mood Elevation and Behavioral Activation with Antidepressant Treatment of Juvenile Depressive and Anxiety Disorders: A Systematic Review

Excessive Mood Elevation and Behavioral Activation with Antidepressant Treatment of Juvenile Depressive and Anxiety Disorders: A Systematic Review

Prevalence and correlates of bipolar I disorder among adults with primary youth‐onset anxiety disorders

The Efficacy and Tolerability of Methylphenidate and Behavior Modification in Children with Attention-Deficit/Hyperactivity Disorder and Severe Mood Dysregulation

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