Antidepressant-Coincident Mania in Children and Adolescents Treated with Selective Serotonin Reuptake Inhibitors

Abstract

Several factors have amplified concern about the possibility that antidepressant medication may contribute to induction of pediatric mania. These include the high rate of antidepressant medication prescription, the recent surge in the rate of diagnosis of pediatric bipolar disorder in the USA, and a growing number of case reports and clinical studies showing coincidence of manic symptoms with antidepressant pharmacotherapy in both youths and adults. However, the question of how medications and manic symptoms might be related is complicated, and decisive research studies with rigorous designs for evaluating the issues have not been published. The situation makes it difficult for practitioners to make good, evidence-based decisions. The scientific literature is ambiguous, and the stakes are high. We review the extant literature, offer seven different conceptual models of how medication and mania might be related, and comment on the evidence and clinical implications of each.

Keywords :

• adolescents
• antidepressant
• children
• citalopram
• fluoxetine
• induced hypomania
• induced mania
• paroxetine
• sertraline
• SSRI
• switch
• venlafaxine
• youth

Financial & competing interests disclosure

This research was partly supported by NIH R01 MH 69774 (Soares), RR 20571 (Soares), as well as NIH R01 MH066647 (Youngstrom). Megan F Joseph, MA, and Eric A Youngstrom, PhD, have no financial relationships with any pharmaceutical company. Jair Soares, MD, is on the speaker‘s bureau at Eli Lilly and AstraZeneca, is a consultant for Organon and Shire, and receives grant funding from Pfizer and GlaxoSmithKline. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Additional information

Funding

This research was partly supported by NIH R01 MH 69774 (Soares), RR 20571 (Soares), as well as NIH R01 MH066647 (Youngstrom). Megan F Joseph, MA, and Eric A Youngstrom, PhD, have no financial relationships with any pharmaceutical company. Jair Soares, MD, is on the speaker‘s bureau at Eli Lilly and AstraZeneca, is a consultant for Organon and Shire, and receives grant funding from Pfizer and GlaxoSmithKline. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.