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Cited by 79Bipolar Disorder and TreatmentAttention Deficit Hyperactivity DisorderSchizophrenia research and treatment

Antidepressants and Psychostimulants in Pediatric Populations: Is there an Association with Mania?

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Goldsmith, Michelle, Singh, Manpreet, Chang, Kiki·2011·Pediatric Drugs
DOI 10.2165/11591660-000000000-00000PMC PMC3394932
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Abstract

This article reviews the literature that examines whether exposure to psychostimulants or antidepressants precipitates or exacerbates manic symptoms, or decreases the age at onset of mania in pediatric populations. A PubMed search using relevant key words identified studies targeting five distinct clinical groups: (i) youth without a diagnosis of bipolar disorder (BD) at the time of exposure to psychostimulants; (ii) youth with a diagnosis of BD at the time of exposure to psychostimulants; (iii) youth without a diagnosis of BD at the time of exposure to antidepressants; (iv) youth with a diagnosis of BD at the time of exposure to antidepressants; and (v) youth who develop BD after exposure to these medications. In patients with attention-deficit hyperactivity disorder (ADHD), the risk for mania was found to be relatively low with the use of psychostimulants. For patients with BD and ADHD, effective mood stabilization is important prior to adding a stimulant. For children with depression and/or anxiety, the risk of antidepressant-induced mania (AIM) was generally low (<2%), but the risk of general 'activation' secondary to a selective serotonin reuptake inhibitor (SSRI) may be greater (2-10%). However, rates of AIM in specialty clinics appear to be much higher. SSRIs may be particularly problematic in specific populations, such as those with some symptoms of mania or a family history of BD, but the precise risk is unknown. There is no clear evidence that stimulants or SSRIs accelerate the natural course of BD development in overall samples, but in individual cases prescribers should proceed cautiously when using these agents in youth already at risk for developing BD, such as those with ADHD and mood dysregulation, a history of prior AIM, a history of psychosis, or a family history of BD.

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Authors
Goldsmith, M., Singh, M., & Chang, K.
Affiliations
Stanford Medicine (US)
Corresponding author
Chang, Kiki
ORCID
Venue
Pediatric Drugs
Publisher
Springer Science and Business Media LLC
Published
2011-08
Volume
13
Issue
4
Pages
225-243
ISSN
1174-5878 (ISSN-L)
DOI
10.2165/11591660-000000000-00000
PMC
PMC3394932
OpenAlex
W1982888631
Cited by
79
References
101
Citations by year
2026: 2 · 2025: 5 · 2024: 5 · 2023: 4 · 2022: 4 · 2021: 4 · 2020: 6 · 2019: 4 · 2018: 6 · 2017: 8 · 2016: 5 · 2015: 5 · 2014: 6 · 2013: 6 · 2012: 8
FWCI
0.88
Type
journal article
Language
en
Open access
Locations
  • Pediatric Drugs (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (1k23mh085919-01)
  • National Institute of Mental Health (K23-MH085919)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
antidepressants, psychostimulants, bipolar disorder, antidepressant-induced mania, attention deficit hyperactivity disorder, selective serotonin reuptake inhibitors, pediatric bipolar disorder, mood stabilization, children and adolescents
MeSH terms
Age Factors, Central Nervous System Stimulants, Antidepressive Agents, Anxiety Disorders, Attention Deficit Disorder with Hyperactivity, Bipolar Disorder, Child, Depressive Disorder, Humans, Risk Factors, Age of Onset

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