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

Gianni L Faedda1, Ross J Baldessarini, Ira P Glovinsky

  • 1Lucio Bini Mood Disorders Center, New York, NY 10022, USA. gianni.faedda@moodcenter.org <gianni.faedda@moodcenter.org>

Journal of Affective Disorders
|October 7, 2004
PubMed

Insights

Pediatric bipolar disorder (BPD) treatment with antidepressants or stimulants can trigger mania or mood cycling in 58% of children. This treatment-emergent mania (TEM) often occurs within weeks and may lead to misdiagnosis.

Area of Science:

  • Child and Adolescent Psychiatry
  • Pharmacology
  • Mental Health Research

Background:

  • Pediatric bipolar disorder (BPD) is frequently misdiagnosed as other childhood disorders.
  • Antidepressant and stimulant medications are commonly prescribed for pediatric BPD.
  • Adverse outcomes of these treatments in children are not well-defined.

Purpose of the Study:

  • To evaluate the risk and timing of treatment-emergent mania (TEM) or increased mood cycling in children diagnosed with BPD.
  • To analyze the association between pharmacological treatment and adverse mood events in pediatric BPD.

Main Methods:

  • Retrospective analysis of clinical records for 82 children meeting modified DSM-IV criteria for BPD.
  • Operationally defined assessment of TEM or increased mood cycling following pharmacological treatment.
  • Evaluation of medication types (antidepressants, stimulants) and latency to adverse events.

Main Results:

  • 58% of children exposed to mood-elevating agents developed TEM within a median of 14 days.
  • TEM occurred more frequently with antidepressants (44%) than stimulants (18%).
  • TEM led to initial BPD recognition in 17% of cases; some children exhibited severe behavioral changes.

Conclusions:

  • Treatment-emergent mania (TEM) is a significant risk in children with probable juvenile BPD, occurring in 58% within weeks of new medication exposure.
  • Early-onset anxiety and female gender were associated with TEM.
  • Findings highlight the need for careful monitoring during pharmacological treatment of pediatric BPD.
Abstract

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