[Bipolar depression in childhood and adolescence]

Depressive episodes in the course of bipolar disorders present various challenges for diagnosis and treatment. This review gives an overview of the epidemiology, etiology, diagnosis, course and the treatment of bipolar depression in children and adolescents as well as existing problems for clinical practice. Usually it takes a longer period until affected patients with bipolar disorder receive correct diagnosis and treatment. In many cases, unipolar and bipolar depressive episodes may only be distinguished in the long-term course. Manic episodes in children and adolescents often show atypical features, and hypomanic episodes are often not perceived as impairing. Comorbidities are common and complicate the diagnostic process. Up to now, there is no German child and adolescent psychiatric instrument to support diagnosis. Cogitive behavioural therapy, Interpersonal Therapy and Family-focussed Therapy for adolescents seem promising. Regarding psychopharmacotherapy there is only limited evidence to guide clinical decisions for youth. A better understanding of the prodromal phase appears to be important. Delay of treatment initiation could be minimized by a closer collaboration between the various treatment systems, e. g. using centers for early recognition.