Antidepressant exposure in bipolar children.

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.