title: Psychotropic medication exposure and age at onset of bipolar disorder in offspring of parents with bipolar disorder.
abstract: OBJECTIVE
  Exposure to psychotropic medications before the onset of bipolar disorder (BD) in children may have profound effects on the course of illness. Both antidepressant and stimulant exposure have been proposed to hasten the course of BD development, whereas mood stabilizers have been proposed as protective. We sought to describe psychotropic medication exposure in a cohort of children at risk for BD and retrospectively determine the effect of medication exposure on age at onset (AAO) of BD.
  
  
  METHODS
  Subjects were 106 children and adolescents who had at least 1 parent with BD. Of these, 63 had BD I or BD II and 43 had subsyndromal symptoms of BD. AAO was determined as nearest month of first manic or hypomanic episode. Past psychotropic medication exposure prior to AAO was determined through interview and chart review.
  
  
  RESULTS
  Both groups had high rates of exposure to psychotropic medications. Antidepressant or stimulant exposure was not correlated with an earlier AAO of BD. However, mood stabilizer exposure was associated with a later AAO.
  
  
  CONCLUSIONS
  Children with full or subsyndromal BD are frequently exposed to a variety of psychotropic medications before their first manic episode. Our findings do not support that early stimulant or antidepressant exposure leads to an earlier AAO of BD. However, early mood stabilizer exposure may be associated with delayed AAO. Longitudinal studies are needed to clarify these results.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California 94305-5540, USA.
authors.forename: Kiki D
authors.initials: KD
authors.lastname: Chang
authors.forename: Kirti
authors.initials: K
authors.lastname: Saxena
authors.forename: Meghan
authors.initials: M
authors.lastname: Howe
authors.forename: Diana
authors.initials: D
authors.lastname: Simeonova
mesh_terms: D000293:Adolescent; D000367:Age Factors; D017668:Age of Onset; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000235:genetics; D002140:California; D002648:Child; D016241:Child of Impaired Parents / Q000523:psychology*; D015331:Cohort Studies; D005192:Family Health; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D010287:Parent-Child Relations; D010290:Parents; D011569:Psychiatric Status Rating Scales; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D011619:Psychotropic Drugs