Therapeutic dilemmas in the pharmacotherapy of bipolar depression in the young

被引:76
作者
Biederman, J
Mick, E
Spencer, TJ
Wilens, TE
Faraone, SV
机构
[1] Massachusetts Gen Hosp, Child Psychiat Serv, Pediat Psychopharmacol Unit, Boston, MA 02114 USA
[2] Harvard Univ, Sch Med, Boston, MA USA
[3] Harvard Inst Psychiat Epidemiol & Genet, Boston, MA USA
[4] Harvard Univ, Sch Med, Brockton W Roxbury Vet Affairs Med Ctr, Boston, MA USA
[5] Massachusetts Mental Hlth Ctr, Boston, MA 02115 USA
关键词
D O I
10.1089/10445460050167296
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Pediatric bipolar disorder is commonly mixed with co-occurring symptoms of major depression and mania, Knowledge has begun to accumulate on the treatment of the mania component, but limited information is available to guide the therapeutic approach to bipolar depression. To this end, we reviewed the medical charts of 59 patients with diagnosis of DSM-III-R bipolar disorder from an outpatient pediatric psychopharmacology clinic. Multivariate methods were used to model the probability of improvement and relapse at each visit of clinical follow-up, Serotonin-specific antidepressants were significantly associated with both an increased rate of improvement of bipolar depression-relative risk = 6.7 (1.9-23.6); p = 0.003-and a significantly greater probability of relapse of manic symptomatology-relative risk = 3.0 (1.2-7.8); p = 0.02, Although mood stabilizers improved manic symptomatology, they had no demonstrable effect on the symptoms of bipolar depression. Despite the increased risk of mood destabilization, serotonin-specific antidepressants did not interfere with the antimanic effects of mood stabilizers. Because bipolar youth commonly come to clinical practice with depression, these results underscore the importance of assessing a lifetime history of bipolar disorder in making treatment decisions in depressed youth.
引用
收藏
页码:185 / 192
页数:8
相关论文
共 18 条
[1]  
[Anonymous], 1987, DIAGNOSTIC STAT MANU, V4th
[2]   Resolved: Mania is mistaken for ADHD in prepubertal children - Affirmative [J].
Biederman, J .
JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY, 1998, 37 (10) :1091-1093
[3]   The naturalistic course of pharmacologic treatment of children with maniclike symptoms: A systematic chart review [J].
Biederman, J ;
Mick, E ;
Bostic, JQ ;
Prince, J ;
Daly, J ;
Wilens, TE ;
Spencer, T ;
Garcia-Jetton, J ;
Russell, R ;
Wozniak, J ;
Faraone, SV .
JOURNAL OF CLINICAL PSYCHIATRY, 1998, 59 (11) :628-637
[4]   Systematic chart review of the pharmacologic treatment of comorbid attention deficit hyperactivity disorder in youth with bipolar disorder [J].
Biederman, J ;
Mick, E ;
Prince, J ;
Bostic, JQ ;
Wilens, TE ;
Spencer, T ;
Wozniak, J ;
Faraone, SV .
JOURNAL OF CHILD AND ADOLESCENT PSYCHOPHARMACOLOGY, 1999, 9 (04) :247-256
[5]  
CARLSON GA, 1984, PSYCHIAT DEV, V2, P273
[6]  
CARLSON GA, 1983, AFFECTIVE DISORD, P61
[7]   Risperidone treatment for juvenile bipolar disorder: A retrospective chart review [J].
Frazier, JA ;
Meyer, MC ;
Biederman, J ;
Wozniak, J ;
Wilens, TE ;
Spencer, TJ ;
Kim, GS ;
Shapiro, S .
JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY, 1999, 38 (08) :960-965
[8]   Child and adolescent bipolar disorder: A review of the past 10 years [J].
Geller, B ;
Luby, J .
JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY, 1997, 36 (09) :1168-1176
[9]   RATE AND PREDICTORS OF PREPUBERTAL BIPOLARITY DURING FOLLOW-UP OF 6-YEAR-OLD TO 12-YEAR-OLD DEPRESSED CHILDREN [J].
GELLER, B ;
FOX, LW ;
CLARK, KA .
JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY, 1994, 33 (04) :461-468
[10]  
GOODWIN FK, 1990, MANIC DEPRESSIVE ILL, P630