title: Initiation of stimulant and antidepressant medication and clinical presentation in juvenile bipolar I disorder.
abstract: OBJECTIVE
  The primary purpose of this study was to examine the extent to which the initiation of stimulant and antidepressant medication was associated with the subsequent onset of juvenile bipolar I disorder (BP I). Another aim was to investigate differences in clinical presentation between youths prescribed stimulant or antidepressant medication before and after the onset of juvenile BP I disorder.
  
  
  METHODS
  Youths between the ages of 5 and 17 years meeting full, unmodified DSM-IV diagnostic symptom criteria for BP were included in this study. Data regarding the age of onset of BP I, psychiatric comorbidities, and current symptoms of mania and depression were obtained. Medication history was recorded as part of the assessment interview with parents and youths.
  
  
  RESULTS
  Of the 245 youths with BP I, 65% (n = 160) were treated with stimulant medication; 32% (56/173) were treated after the onset of BP I, and 19% (32/173) were treated before the onset of BP I. Forty-six percent (113/245) were treated with antidepressant medication; 33% (67/206) were treated after the onset of BP I, and 3% (7/206) were treated before the onset of BP I. Patients who were treated with stimulants after the onset of BP I were significantly more likely to be younger (p < 0.0001). Patients who were treated with antidepressants before the onset of BP I were significantly more likely to be older and to have lower levels of mania on the Young Mania Rating Scale at assessment (p < 0.01).
  
  
  CONCLUSIONS
  Data from this retrospective case series do not support the association between initial stimulant or antidepressant use and the onset of BP I or presenting symptoms of depression or manic symptoms.
authors.affiliation: Department of Psychiatry, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, OH 44106-5080, USA. maria.pagano@uhhs.com
authors.forename: Maria E
authors.initials: ME
authors.lastname: Pagano
authors.forename: Christine A
authors.initials: CA
authors.lastname: Demeter
authors.forename: Jon E
authors.initials: JE
authors.lastname: Faber
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Calabrese
authors.forename: Robert L
authors.initials: RL
authors.lastname: Findling
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D000928:Antidepressive Agents