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Cited by 70Bipolar Disorder and TreatmentTreatment of Major DepressionChild and Adolescent Psychosocial and Emotional Development

Antidepressant tolerability in anxious and depressed youth at high risk for bipolar disorder: a prospective naturalistic treatment study

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Strawn, Jeffrey R, Adler, Caleb M, McNamara, Robert K, Welge, Jeffrey A, Bitter, Samantha M, Mills, Neil P, Barzman, Drew H, Cerullo, Michael A +3 more·2014·Bipolar Disorders
DOI 10.1111/bdi.12113PMC PMC9435372
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Abstract

Objective: Depressive and anxiety disorders are common in youth who are at risk for bipolar disorder (i.e., youth who have at least one parent with bipolar disorder) and antidepressants are commonly prescribed as treatment. However, there are few data regarding the safety and tolerability of antidepressants in this population. Therefore, we sought to prospectively examine the effects of these medications in children and adolescents who are diagnosed with depressive or anxiety disorders and have a parent with bipolar I disorder. Methods: Youth aged 9–20 years, with at least one parent with bipolar I disorder [high risk ( HR )], were recruited (n = 118) and assessed using semi‐structured diagnostic interviews. Participants were prospectively evaluated using a modified version of the Longitudinal Interval Follow‐up Evaluation to assess changes in affective and anxiety symptoms and were treated naturalistically. Results: Over the course of 43–227 weeks (mean duration of follow‐up: 106 ± 55 weeks), 21% (n = 25) of youth had antidepressant exposure and, of these, 57% (n = 12) had an adverse reaction (e.g., irritability, aggression, impulsivity, or hyperactivity) that led to antidepressant discontinuation. Those patients who experienced an adverse reaction were significantly younger than those who did not (p = 0.02) and discontinuation of antidepressant therapy secondary to an adverse event occurred at an average of 16.7 ± 17.4 weeks (median: 11 weeks, range: 2–57 weeks). Cox proportional hazard analyses yielded a hazard ratio of 0.725 (p = 0.03), suggesting that there is a 27% decrease in the likelihood of an antidepressant‐related adverse event leading to discontinuation with each one‐year increase in age. Conclusions: Antidepressant medications may be poorly tolerated in youth with a familial risk for developing mania. Controlled studies further assessing treatments for depression and anxiety in HR youth are urgently needed.

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  • Most available data on antidepressants and the HPA axis come from studies on major depressive disorder and might not be generalizable to bipolar disorder.

    “most available data come from studies on MDD (Anacker et al. 2011), therefore might not be generalizable to BD (Strawn et al. 2014;Valenti et al. 2011).”

    From The HPA axis in bipolar disorder: Systematic review and meta-analysis (2016) · cites this paper as Strawn et al. 2014

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Research works printed but not linked: 3

  1. [7]Dineen Wagner K Bipolar disorder and comorbid anxiety disorders in children and adolescents. J Clin Psychiatry 2006; 67: 16– 20. 16426112
  2. [35]Connolly SD, Bernstein GA; Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry 2007; 46: 267– 283. 17242630
  3. [36]Birmaher B, Brent D, Bernet W Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry 2007; 46: 1503– 1526. 18049300

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Authors
Strawn, J. R., Adler, C. M., McNamara, R. K., Welge, J. A., Bitter, S. M., Mills, N. P., Barzman, D. H., Cerullo, M. A., Chang, K. D., Strakowski, S. M., & DelBello, M. P.
Affiliations
  • University of Cincinnati (US)
  • Cincinnati Children's Hospital Medical Center (US)
  • Stanford Medicine (US)
Corresponding author
Strawn, Jeffrey R
ORCID
Venue
Bipolar Disorders
Publisher
Wiley
Published
2013-08-13
Volume
16
Issue
5
Pages
523-530
ISSN
  • 1398-5647 (ISSN-L)
  • 1399-5618
DOI
10.1111/bdi.12113
PMC
PMC9435372
OpenAlex
W2044695991
Cited by
70
References
38
Citations by year
2026: 2 · 2025: 2 · 2024: 4 · 2023: 3 · 2022: 6 · 2021: 10 · 2020: 7 · 2019: 6 · 2018: 7 · 2017: 3 · 2016: 5 · 2015: 9 · 2014: 5 · 2013: 1
FWCI
4.74
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Bipolar Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR000077)
  • National Institute of Mental Health (R34MH083924, R01MH080973, P50MH077138)
  • National Center for Research Resources
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
antidepressant tolerability, antidepressant side effects, adolescent depression, youth anxiety disorders, antidepressant discontinuation, irritability, aggression, impulsivity, hyperactivity, children and adolescents
MeSH terms
Adolescent, Antidepressive Agents, Anxiety, Bipolar Disorder, Child, Depression, Female, Humans, Male, Probability, Prospective Studies, Psychiatric Status Rating Scales, Risk, Disease Progression, Young Adult

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