Pediatric Antidepressant Use linked to minimal Short-Term Risk of Mania: JAMA

A recent study by Suvi Virtanen and colleagues delved into the contentious topic of antidepressant use in pediatric patients with unipolar depression. The study published in JAMA Psychiatry did not uncover any indications of treatment-induced mania or hypomania in children and adolescents who were diagnosed with unipolar depression.

Spanning the period from July 1, 2006, to December 31, 2019, and analyzed between May 1, 2022, and June 28, 2023, this comprehensive study examined data from nationwide inpatient and outpatient care. It included individuals aged 4 to 17 years who had been diagnosed with depression but had no prior diagnosis of mania or hypomania, bipolar disorder, psychosis, or treatment with mood stabilizers like lithium, valproate, or carbamazepine.

The study involved 43,677 patients, of whom 28,885 were girls, with a median age of 15 years. The cohort was divided into a treatment group, consisting of those who initiated antidepressant medication within 90 days of diagnosis, and a control group, comprising patients who did not initiate antidepressants within this timeframe.

The primary outcomes examined were the diagnosis of mania or hypomania or the initiation of mood stabilizer therapy. The results revealed that by the end of 12 weeks, the cumulative incidence of mania or hypomania was 0.26% in the treatment group and 0.20% in the control group, with a minimal risk difference of 0.06%. At 52 weeks, the cumulative incidence was 0.79% in the treatment group and 0.52% in the control group, with a risk difference of 0.28%.

These findings suggest that within the initial 12-week period, there is no substantial evidence supporting treatment-emergent mania or hypomania in children and adolescents prescribed antidepressants. However, a slight increase in risk emerged with longer follow-up.

Notably, certain patient characteristics, such as hospitalizations, parental bipolar disorder, and the use of antipsychotics and antiepileptics, were identified as important predictors of mania or hypomania within the first 12 weeks. Further research may be needed to fully understand the potential risks and benefits of these medications in children and adolescents with depression.

Source:

Virtanen, S., Lagerberg, T., Takami Lageborn, C., Kuja-Halkola, R., Brikell, I., Matthews, A. A., Lichtenstein, P., D’Onofrio, B. M., Landén, M., & Chang, Z. (2023). Antidepressant Use and Risk of Manic Episodes in Children and Adolescents With Unipolar Depression. In JAMA Psychiatry. American Medical Association (AMA). https://doi.org/10.1001/jamapsychiatry.2023.3555