Antidepressant-emergent mood switch in Korean adolescents with mood disorder

The objectives of this study were to compare clinical characteristics of children and adolescents who experienced antidepressant-emergent mood switch (AEMS) and those who did not, and to investigate the predictors of AEMS in a clinical sample of Korean children and adolescents.

Two psychiatrists retrospectively reviewed the medical records of 115 children and adolescents (age, 15.0 [2.0] years; 45 boys) that were prescribed antidepressants or lamotrigine for the treatment of a depressive episode of bipolar or depressive disorders from March 2010 to February 2012 at the Department of Psychiatry of Asan Medical Center. The diagnosis was reviewed and confirmed for each subject. Demographic information, clinical characteristics, family history, and psychiatric comorbidities were compared across subjects with and without AEMS.

Twelve subjects (10.4%) experienced AEMS. The latency to AEMS was 25.9 (20.9) days (range, 2-56 days; median, 18 days). Antidepressant-emergent mood switch was more frequent in subjects with bipolar disorder (BD) than in subjects with depressive disorder (P < 0.001) and in subjects with high socioeconomic status (P < 0.001). Previous suicidal attempt (P = 0.001), previous antidepressant exposure (P = 0.001), number of previous antidepressant exposures (P < 0.001), family history of other psychiatric disorder (P = 0.001), and concomitant antipsychotics (P = 0.006) were more common in subjects with AEMS than in subjects without AEMS. In multivariate logistic regression, diagnosis of BD (odds ratio [95% confidence interval], 15.94 [1.83-139.16]), concomitant antipsychotics (26.90 [2.43-297.38]), and family history of other psychiatric disorder (39.55 [3.05-512.22]) were significant predictors of AEMS.

Children and adolescents who experienced AEMS had distinct profiles of clinical characteristics. Antidepressant-emergent mood switch may be more associated with BD than with depressive disorder.