youngest most at risk of Bi-Polar 111 from exposure to ssri's...Reuters Health

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" Antidepressant drug therapy can precipitate mania in vulnerable

individuals

..............Antidepressant-age interactions showed significant

inverse age effects for selective serotonin reuptake inhibitors

............... " The hazard was highest for the peripubertal group

of 10- to 14-year-old patients

NEW YORK (Reuters Health) Aug 20 - Patient age is an effect modifier

on antidepressant-induced manic conversion, according to study in

the August issue of the Archives of Pediatric and Adolescent

Medicine.

" Antidepressant drug therapy can precipitate mania in vulnerable

individuals, but little is known about the effects of age on this

phenomenon, " write Dr. Andres , of Yale University School of

Medicine, New Haven, Connecticut, and colleagues.

The researchers used an administrative national database of linked

outpatient and pharmacy claims to assess the risk of conversion to

mania by antidepressant class and patient age in those between the

ages of 5 and 29 years. They evaluated the proportion and cumulative

hazard of manic conversion for children, adolescents, and young

adults with an anxiety or nonbipolar mood disorder. They defined

manic conversion as a new diagnosis of bipolar illness.

Of 87,920 patients included in the sample, 4786 (5.4%) converted to

mania over a median follow-up of 41 weeks. Antidepressant medication

was used by a total of 32,864 patients (37.4%). Multivariate

analysis demonstrated that an increased risk of conversion to mania

was associated with antidepressant exposure versus no antidepressant

exposure (hazard ratios: 3.9 for tricyclic antidepressants, 3.8

for " other " antidepressants, and 2.1 for selective serotonin

reuptake inhibitors).

Antidepressant-age interactions showed significant inverse age

effects for selective serotonin reuptake inhibitors and other

antidepressants (p < 0.001 for both). No such effects were found for

tricyclic antidepressants.

" The hazard was highest for the peripubertal group of 10- to 14-year-

old patients, such that treating as few as 10 children with an

antidepressant agent could result in at least 1 conversion event,

compared with 23 among 15- to 29-year-olds, " Dr. and

colleagues write.

" Our findings must be considered preliminary associations and must

not be taken to equate direct causality, especially in light of the

limitations we outlined earlier, " the authors write.

Still, they suggest that " caution and restraint may be especially

pertinent wen treating children whose symptoms are not a major

source of impairment, those with a strong family history of bipolar

disorder, or those who have not yet tried (and failed)

psychotherapeutic interventions of proven efficacy. "

Arch Pediatr Adolesc Med 2004;158:773-780.

Reuters Health Information 2004. © 2004 Reuters Ltd.

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